|
ER-EVAC SUBUNG HEMATO-BIL
|
Facility
|
OP
|
$214.00
|
|
| Hospital Charge Code |
5790270
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$81.32
|
| Rate for Payer: Aetna Medicare Advantage |
$64.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.57
|
| Rate for Payer: Cigna Commercial |
$107.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.67
|
|
|
ER EVACUATION SUBNGUAL HEMATOM
|
Facility
|
OP
|
$273.34
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
5700512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.55
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$197.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.24
|
|
|
ER EVACUATION SUBNGUAL HEMATOM
|
Facility
|
IP
|
$273.34
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
5700512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.00
|
|
|
ER EVALUATEPT USE OF INHALER
|
Facility
|
OP
|
$182.75
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
5700656
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$707.61
|
| Rate for Payer: Aetna Medicare Advantage |
$842.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$939.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$939.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$260.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$123.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$939.06
|
| Rate for Payer: Cigna Commercial |
$521.47
|
| Rate for Payer: Cigna Medicare Advantage |
$260.15
|
| Rate for Payer: Clover Medicare Advantage |
$247.14
|
| Rate for Payer: EmblemHealth Commercial |
$780.45
|
| Rate for Payer: Humana Medicare Advantage |
$267.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$260.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.83
|
| Rate for Payer: Oxford Commercial |
$885.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$260.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$260.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.84
|
|
|
ER EVALUATEPT USE OF INHALER
|
Facility
|
IP
|
$182.75
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
5700656
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$27.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.41
|
|
|
ER-EXC H-F-NK-SP B9 0.5<
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
5790005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$368.55 |
| Max. Negotiated Rate |
$368.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$368.55
|
|
|
ER-EXC H-F-NK-SP B9 0.5<
|
Facility
|
OP
|
$2,457.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
5790005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.11 |
| 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 |
$133.35
|
| 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 |
$737.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$368.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| 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 |
$65.11
|
|
|
ER-EXCISIN BENGN LSION-BI
|
Facility
|
IP
|
$1,304.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
5790260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$195.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$195.60
|
|
|
ER-EXCISIN BENGN LSION-BI
|
Facility
|
OP
|
$1,304.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
5790260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.56 |
| Max. Negotiated Rate |
$3,036.77 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$109.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,036.77
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$391.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$195.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.56
|
|
|
ER-EXCISION NAIL FOLD-BIL
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
5790280
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$1,743.30 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,743.30
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.57
|
|
|
ER-EXCISION NAIL FOLD-BIL
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
5790280
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.80
|
|
|
ER EXCISION NAIL PARTIAL COMP
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
5700513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.44 |
| Max. Negotiated Rate |
$1,743.30 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$237.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,743.30
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$412.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.44
|
|
|
ER EXCISION NAIL PARTIAL COMP
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
5700513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.25 |
| Max. Negotiated Rate |
$206.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.25
|
|
|
ER EXCISION OF INGROWN TOENAIL
|
Facility
|
IP
|
$468.75
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
5700514
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
|
|
ER EXCISION OF INGROWN TOENAIL
|
Facility
|
OP
|
$468.75
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
5700514
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$1,743.30 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,743.30
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$140.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.42
|
|
|
ER-EXC LES TONGU W/O CLOS
|
Facility
|
OP
|
$5,019.00
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
5790130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$14,218.07 |
| Rate for Payer: Aetna Commercial |
$10,713.67
|
| Rate for Payer: Aetna Medicare Advantage |
$12,761.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,218.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,218.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,938.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$42.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14,218.07
|
| Rate for Payer: Cigna Commercial |
$7,895.42
|
| Rate for Payer: Cigna Medicare Advantage |
$3,938.85
|
| Rate for Payer: Clover Medicare Advantage |
$3,741.91
|
| Rate for Payer: EmblemHealth Commercial |
$11,816.55
|
| Rate for Payer: Humana Medicare Advantage |
$4,057.02
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,938.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,505.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$752.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,938.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,938.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$133.00
|
|
|
ER-EXC LES TONGU W/O CLOS
|
Facility
|
IP
|
$5,019.00
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
5790130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$752.85 |
| Max. Negotiated Rate |
$752.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$752.85
|
|
|
ER-EXPLORE ABDOMIN VESSEL
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 35840
|
| Hospital Charge Code |
5790095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
ER-EXPLORE ABDOMIN VESSEL
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 35840
|
| Hospital Charge Code |
5790095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$521.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,500.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$132.50
|
|
|
ER-EXPLORE WND EXTRMTY-BI
|
Facility
|
OP
|
$2,707.00
|
|
| Hospital Charge Code |
5790290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.74 |
| Max. Negotiated Rate |
$1,353.50 |
| Rate for Payer: Aetna Commercial |
$1,028.66
|
| Rate for Payer: Aetna Medicare Advantage |
$812.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$690.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$690.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$690.28
|
| Rate for Payer: Cigna Commercial |
$1,353.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$812.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$406.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$71.74
|
|
|
ER-EXPLORE WND EXTRMTY-BI
|
Facility
|
IP
|
$2,707.00
|
|
| Hospital Charge Code |
5790290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$406.05 |
| Max. Negotiated Rate |
$406.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$406.05
|
|
|
ER-EXPLORE WOUND ABDOM
|
Facility
|
OP
|
$6,137.00
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
5790055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$8,848.20 |
| Rate for Payer: Aetna Commercial |
$6,667.35
|
| Rate for Payer: Aetna Medicare Advantage |
$7,941.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,848.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,848.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,451.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$211.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,848.20
|
| Rate for Payer: Cigna Commercial |
$4,913.48
|
| Rate for Payer: Cigna Medicare Advantage |
$2,451.23
|
| Rate for Payer: Clover Medicare Advantage |
$2,328.67
|
| Rate for Payer: EmblemHealth Commercial |
$7,353.69
|
| Rate for Payer: Humana Medicare Advantage |
$2,524.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,451.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,841.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$920.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$162.63
|
|
|
ER-EXPLORE WOUND ABDOM
|
Facility
|
IP
|
$6,137.00
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
5790055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$920.55 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$920.55
|
|
|
ER EXTENDED - IV
|
Facility
|
IP
|
$14,610.29
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
5700091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,191.54 |
| Max. Negotiated Rate |
$2,191.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,191.54
|
|
|
ER EXTENDED - IV
|
Facility
|
OP
|
$14,610.29
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
5700091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$2,744.00 |
| Rate for Payer: Aetna Commercial |
$1,348.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,606.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,789.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,789.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$495.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,789.40
|
| Rate for Payer: Cigna Commercial |
$993.68
|
| Rate for Payer: Cigna Medicare Advantage |
$495.72
|
| Rate for Payer: Clover Medicare Advantage |
$470.93
|
| Rate for Payer: EmblemHealth Commercial |
$1,487.16
|
| Rate for Payer: Humana Medicare Advantage |
$510.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$495.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,397.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Oxford Commercial |
$2,186.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,191.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,744.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$495.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$495.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$450.00
|
|
