|
ER-INTRA-AORTIC BALLOON CATH
|
Facility
|
OP
|
$22,823.38
|
|
|
Service Code
|
HCPCS 33967
|
| Hospital Charge Code |
5780180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$550.04 |
| Max. Negotiated Rate |
$20,074.00 |
| Rate for Payer: Aetna Commercial |
$8,672.88
|
| Rate for Payer: Aetna Medicare Advantage |
$6,847.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,819.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,819.96
|
| 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 |
$5,819.96
|
| Rate for Payer: Cigna Commercial |
$11,411.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,847.01
|
| Rate for Payer: Oxford Commercial |
$11,667.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,423.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$20,074.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$550.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$604.82
|
|
|
ER INTRA ARTERIAL INFUSION
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 96373
|
| Hospital Charge Code |
5700440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
ER INTRA ARTERIAL INFUSION
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 96373
|
| Hospital Charge Code |
5700440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$912.17 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$912.17
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.62
|
|
|
ER INTRAOSSEOUS INFUSION
|
Facility
|
OP
|
$1,550.25
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
5700784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$1,915.74 |
| Rate for Payer: Aetna Commercial |
$1,443.56
|
| Rate for Payer: Aetna Medicare Advantage |
$1,719.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,915.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,915.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$530.72
|
| 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 |
$1,915.74
|
| Rate for Payer: Cigna Commercial |
$1,063.82
|
| Rate for Payer: Cigna Medicare Advantage |
$530.72
|
| Rate for Payer: Clover Medicare Advantage |
$504.18
|
| Rate for Payer: EmblemHealth Commercial |
$1,592.16
|
| Rate for Payer: Humana Medicare Advantage |
$546.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$530.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$465.07
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$232.54
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.08
|
|
|
ER INTRAOSSEOUS INFUSION
|
Facility
|
IP
|
$1,550.25
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
5700784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$232.54 |
| Max. Negotiated Rate |
$232.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$232.54
|
|
|
ER INT REP FACE 12.6-20
|
Facility
|
OP
|
$2,305.60
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
5700538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.10 |
| 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 |
$303.22
|
| 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 |
$691.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.84
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$61.10
|
|
|
ER INT REP FACE 12.6-20
|
Facility
|
IP
|
$2,305.60
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
5700538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.84 |
| Max. Negotiated Rate |
$345.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.84
|
|
|
ER INT REP FACE 20.1-30
|
Facility
|
OP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12056
|
| Hospital Charge Code |
5700713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.67 |
| 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 |
$410.45
|
| 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 |
$517.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$258.50
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.67
|
|
|
ER INT REP FACE 20.1-30
|
Facility
|
IP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12056
|
| Hospital Charge Code |
5700713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.50 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$258.50
|
|
|
ER INT REP FACE 2.5-5.0
|
Facility
|
IP
|
$687.50
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
5700535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.12 |
| Max. Negotiated Rate |
$103.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.12
|
|
|
ER INT REP FACE 2.5-5.0
|
Facility
|
OP
|
$687.50
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
5700535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.22 |
| 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 |
$201.11
|
| 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 |
$206.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.12
|
| 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 |
$18.22
|
|
|
ER INT REP FACE > 30 CM
|
Facility
|
OP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12057
|
| Hospital Charge Code |
5700714
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.67 |
| 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 |
$410.51
|
| 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 |
$517.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$258.50
|
| 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 |
$45.67
|
|
|
ER INT REP FACE > 30 CM
|
Facility
|
IP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12057
|
| Hospital Charge Code |
5700714
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.50 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$258.50
|
|
|
ER INT REP FACE 5.1-7.5
|
Facility
|
OP
|
$1,813.80
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
5700536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.07 |
| 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 |
$214.32
|
| 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 |
$544.14
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$272.07
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$48.07
|
|
|
ER INT REP FACE 5.1-7.5
|
Facility
|
IP
|
$1,813.80
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
5700536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$272.07 |
| Max. Negotiated Rate |
$272.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$272.07
|
|
|
ER INT REP FACE 7.6-12.5
|
Facility
|
IP
|
$737.50
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
5700537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.62 |
| Max. Negotiated Rate |
$110.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.62
|
|
|
ER INT REP FACE 7.6-12.5
|
Facility
|
OP
|
$737.50
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
5700537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$19.54 |
| 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 |
$237.47
|
| 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 |
$221.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.62
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.54
|
|
|
ER INT REP FACE UP TO 2.5
|
Facility
|
IP
|
$668.75
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
5700534
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.31 |
| Max. Negotiated Rate |
$100.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.31
|
|
|
ER INT REP FACE UP TO 2.5
|
Facility
|
OP
|
$668.75
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
5700534
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.72 |
| 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 |
$151.70
|
| 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 |
$200.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.31
|
| 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 |
$17.72
|
|
|
ER INT REP NEK HAD FOOT2.6-7.5
|
Facility
|
IP
|
$687.50
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
5700532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.12 |
| Max. Negotiated Rate |
$103.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.12
|
|
|
ER INT REP NEK HAD FOOT2.6-7.5
|
Facility
|
OP
|
$687.50
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
5700532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.22 |
| 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 |
$201.56
|
| 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 |
$206.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.12
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.22
|
|
|
ER INT REP NEK HAD FOT12.6-20
|
Facility
|
OP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
5700710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.67 |
| Max. Negotiated Rate |
$3,169.46 |
| Rate for Payer: Aetna Commercial |
$2,388.27
|
| Rate for Payer: Aetna Medicare Advantage |
$2,844.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,169.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,169.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$878.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$304.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,169.46
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: Cigna Medicare Advantage |
$878.04
|
| Rate for Payer: Clover Medicare Advantage |
$834.14
|
| Rate for Payer: EmblemHealth Commercial |
$2,634.12
|
| Rate for Payer: Humana Medicare Advantage |
$904.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$878.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$517.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$258.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.67
|
|
|
ER INT REP NEK HAD FOT12.6-20
|
Facility
|
IP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
5700710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.50 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$258.50
|
|
|
ER INT REP NEK HAD FOT20.1-30
|
Facility
|
IP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
5700711
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.50 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$258.50
|
|
|
ER INT REP NEK HAD FOT20.1-30
|
Facility
|
OP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
5700711
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.67 |
| Max. Negotiated Rate |
$3,169.46 |
| Rate for Payer: Aetna Commercial |
$2,388.27
|
| Rate for Payer: Aetna Medicare Advantage |
$2,844.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,169.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,169.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$878.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$369.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,169.46
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: Cigna Medicare Advantage |
$878.04
|
| Rate for Payer: Clover Medicare Advantage |
$834.14
|
| Rate for Payer: EmblemHealth Commercial |
$2,634.12
|
| Rate for Payer: Humana Medicare Advantage |
$904.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$878.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$517.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$258.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.67
|
|
