|
ER CLSD TX HUM COND FX W MAN
|
Facility
|
OP
|
$2,622.50
|
|
|
Service Code
|
HCPCS 24577
|
| Hospital Charge Code |
5700744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$6,895.75 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$292.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,895.75
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$69.50
|
|
|
ER CLSD TX HUM COND FX W/O MAN
|
Facility
|
OP
|
$906.60
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
5700743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$1,057.82 |
| Rate for Payer: Aetna Commercial |
$797.10
|
| Rate for Payer: Aetna Medicare Advantage |
$949.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,057.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,057.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$293.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,057.82
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: Cigna Medicare Advantage |
$293.05
|
| Rate for Payer: Clover Medicare Advantage |
$278.40
|
| Rate for Payer: EmblemHealth Commercial |
$879.15
|
| Rate for Payer: Humana Medicare Advantage |
$301.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$293.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.98
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.99
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.02
|
|
|
ER CLSD TX HUM COND FX W/O MAN
|
Facility
|
IP
|
$906.60
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
5700743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.99 |
| Max. Negotiated Rate |
$135.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.99
|
|
|
ER CLSD TX HUM EPI FX W MANI
|
Facility
|
OP
|
$1,125.13
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
5700742
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$6,895.75 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$398.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,895.75
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$337.54
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.77
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.82
|
|
|
ER CLSD TX HUM EPI FX W MANI
|
Facility
|
IP
|
$1,125.13
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
5700742
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.77 |
| Max. Negotiated Rate |
$168.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.77
|
|
|
ER CLSD TX HUM EPI FX W/O ANES
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
5700561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CLSD TX HUM EPI FX W/O ANES
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
5700561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$1,057.82 |
| Rate for Payer: Aetna Commercial |
$797.10
|
| Rate for Payer: Aetna Medicare Advantage |
$949.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,057.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,057.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$293.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$223.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,057.82
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: Cigna Medicare Advantage |
$293.05
|
| Rate for Payer: Clover Medicare Advantage |
$278.40
|
| Rate for Payer: EmblemHealth Commercial |
$879.15
|
| Rate for Payer: Humana Medicare Advantage |
$301.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$293.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.94
|
|
|
ER CLSD TX LUNA DISLOC W/MANIP
|
Facility
|
OP
|
$8,605.25
|
|
|
Service Code
|
HCPCS 25690
|
| Hospital Charge Code |
323025690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$6,895.75 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$383.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,895.75
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,581.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,290.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$228.04
|
|
|
ER CLSD TX LUNA DISLOC W/MANIP
|
Facility
|
IP
|
$8,605.25
|
|
|
Service Code
|
HCPCS 25690
|
| Hospital Charge Code |
323025690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,290.79 |
| Max. Negotiated Rate |
$1,290.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,290.79
|
|
|
ER CLSD TX METACARPO W MANI
|
Facility
|
OP
|
$787.35
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
5700829
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$6,895.75 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$231.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,895.75
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.21
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.86
|
|
|
ER CLSD TX METACARPO W MANI
|
Facility
|
IP
|
$787.35
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
5700829
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.10 |
| Max. Negotiated Rate |
$118.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.10
|
|
|
ER CLSD TX MONTEGGIA FX DISLOC
|
Facility
|
OP
|
$10,062.15
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
5700745
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$6,895.75 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$425.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,895.75
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,018.64
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,509.32
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$266.65
|
|
|
ER CLSD TX MONTEGGIA FX DISLOC
|
Facility
|
IP
|
$10,062.15
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
5700745
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,509.32 |
| Max. Negotiated Rate |
$1,509.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,509.32
|
|
|
ER CLSD TX NURSEMAID ELBOW W A
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
5700562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CLSD TX NURSEMAID ELBOW W A
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
5700562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$1,057.82 |
| Rate for Payer: Aetna Commercial |
$797.10
|
| Rate for Payer: Aetna Medicare Advantage |
$949.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,057.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,057.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$293.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$73.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,057.82
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: Cigna Medicare Advantage |
$293.05
|
| Rate for Payer: Clover Medicare Advantage |
$278.40
|
| Rate for Payer: EmblemHealth Commercial |
$879.15
|
| Rate for Payer: Humana Medicare Advantage |
$301.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$293.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.94
|
|
|
ER-CLSD TX OF TBIAL FX-BI
|
Facility
|
OP
|
$453.00
|
|
| Hospital Charge Code |
5790565
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$172.14
|
| Rate for Payer: Aetna Medicare Advantage |
$135.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$115.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$115.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$115.52
|
| Rate for Payer: Cigna Commercial |
$226.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.00
|
|
|
ER-CLSD TX OF TBIAL FX-BI
|
Facility
|
IP
|
$453.00
|
|
| Hospital Charge Code |
5790565
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$67.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.95
|
|
|
ER CLSD TX PROX FIB SFT W MAN
|
Facility
|
OP
|
$10,062.15
|
|
|
Service Code
|
HCPCS 27781
|
| Hospital Charge Code |
5700765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$6,895.75 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$182.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,895.75
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,018.64
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,509.32
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$266.65
|
|
|
ER CLSD TX PROX FIB SFT W MAN
|
Facility
|
IP
|
$10,062.15
|
|
|
Service Code
|
HCPCS 27781
|
| Hospital Charge Code |
5700765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,509.32 |
| Max. Negotiated Rate |
$1,509.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,509.32
|
|
|
ER CLSD TX PROX HUM FX W/O ANE
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
5700555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CLSD TX PROX HUM FX W/O ANE
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
5700555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$1,057.82 |
| Rate for Payer: Aetna Commercial |
$797.10
|
| Rate for Payer: Aetna Medicare Advantage |
$949.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,057.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,057.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$293.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$248.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,057.82
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: Cigna Medicare Advantage |
$293.05
|
| Rate for Payer: Clover Medicare Advantage |
$278.40
|
| Rate for Payer: EmblemHealth Commercial |
$879.15
|
| Rate for Payer: Humana Medicare Advantage |
$301.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$293.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.94
|
|
|
ER CLSD TX RADIAL SFT FX W MAN
|
Facility
|
OP
|
$8,575.05
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
5700747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$6,895.75 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,895.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$292.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,895.75
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,572.51
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,286.26
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$227.24
|
|
|
ER CLSD TX RADIAL SFT FX W MAN
|
Facility
|
IP
|
$8,575.05
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
5700747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,286.26 |
| Max. Negotiated Rate |
$1,286.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,286.26
|
|
|
ER CLSD TX RADIAL SFT FX W/O M
|
Facility
|
OP
|
$906.60
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
5700746
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$1,057.82 |
| Rate for Payer: Aetna Commercial |
$797.10
|
| Rate for Payer: Aetna Medicare Advantage |
$949.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,057.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,057.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$293.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$208.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,057.82
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: Cigna Medicare Advantage |
$293.05
|
| Rate for Payer: Clover Medicare Advantage |
$278.40
|
| Rate for Payer: EmblemHealth Commercial |
$879.15
|
| Rate for Payer: Humana Medicare Advantage |
$301.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$293.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.98
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.99
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.02
|
|
|
ER CLSD TX RADIAL SFT FX W/O M
|
Facility
|
IP
|
$906.60
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
5700746
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.99 |
| Max. Negotiated Rate |
$135.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.99
|
|
