|
ER CLSD TX SCAPULA W/O MANIP
|
Facility
|
OP
|
$906.60
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
5700735
|
|
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 |
$166.69
|
| 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 SCAPULA W/O MANIP
|
Facility
|
IP
|
$906.60
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
5700735
|
|
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 SUP/TRANS HUM FX WO
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
5700560
|
|
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 SUP/TRANS HUM FX WO
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
5700560
|
|
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 |
$293.88
|
| 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 TALUS W/O MANIP
|
Facility
|
IP
|
$906.60
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
5700769
|
|
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 TALUS W/O MANIP
|
Facility
|
OP
|
$906.60
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
5700769
|
|
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 |
$189.98
|
| 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 TARSAL BONE W/O MAN
|
Facility
|
OP
|
$906.60
|
|
|
Service Code
|
HCPCS 28450
|
| Hospital Charge Code |
5700770
|
|
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 |
$166.69
|
| 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 TARSAL BONE W/O MAN
|
Facility
|
IP
|
$906.60
|
|
|
Service Code
|
HCPCS 28450
|
| Hospital Charge Code |
5700770
|
|
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 TIBIAL SHAFT W/ MAN
|
Facility
|
OP
|
$10,062.15
|
|
|
Service Code
|
HCPCS 27752
|
| Hospital Charge Code |
5700764
|
|
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 |
$437.52
|
| 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 TIBIAL SHAFT W/ MAN
|
Facility
|
IP
|
$10,062.15
|
|
|
Service Code
|
HCPCS 27752
|
| Hospital Charge Code |
5700764
|
|
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 TROCHANTER W/O MANI
|
Facility
|
IP
|
$2,622.50
|
|
|
Service Code
|
HCPCS 27238
|
| Hospital Charge Code |
5700756
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.38 |
| Max. Negotiated Rate |
$393.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.38
|
|
|
ER CLSD TX TROCHANTER W/O MANI
|
Facility
|
OP
|
$2,622.50
|
|
|
Service Code
|
HCPCS 27238
|
| Hospital Charge Code |
5700756
|
|
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 |
$372.04
|
| 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 ULNAR SHAFT W/ MANI
|
Facility
|
OP
|
$906.60
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
5700748
|
|
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 |
$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 |
$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 ULNAR SHAFT W/ MANI
|
Facility
|
IP
|
$906.60
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
5700748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.99 |
| Max. Negotiated Rate |
$135.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.99
|
|
|
ER CL TX BIMAL ANK FX W/MANI
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
5700603
|
|
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 |
$265.48
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$723.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.94
|
|
|
ER CL TX BIMAL ANK FX W/MANI
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
5700603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CL TX BIMAL ANKLE FX W/MANI
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
5700604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CL TX BIMAL ANKLE FX W/MANI
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
5700604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.94 |
| 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 |
$396.12
|
| 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 |
$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 |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.94
|
|
|
ER CL TX CARPAL FX W/MAN EACH
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
5700572
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CL TX CARPAL FX W/MAN EACH
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
5700572
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.94 |
| 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 |
$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 |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.94
|
|
|
ER CL TX CARPAL SCAP FX W/O AN
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
5700570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CL TX CARPAL SCAP FX W/O AN
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
5700570
|
|
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 |
$142.30
|
| 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 CL TX COCCYGEAL FX
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 27200
|
| Hospital Charge Code |
5700586
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CL TX COCCYGEAL FX
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS 27200
|
| Hospital Charge Code |
5700586
|
|
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 |
$141.27
|
| 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 CL TX DIS FIB FX W/MANI
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
5700602
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
