|
ER INT REP NEK HAD FOT > 30 CM
|
Facility
|
OP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
5700712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.67 |
| 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 |
$377.91
|
| 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 |
$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 |
$2,451.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.67
|
|
|
ER INT REP NEK HAD FOT > 30 CM
|
Facility
|
IP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
5700712
|
|
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 FOT7.6-12.5
|
Facility
|
IP
|
$2,910.20
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
5700533
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.53 |
| Max. Negotiated Rate |
$436.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$436.53
|
|
|
ER INT REP NEK HAD FOT7.6-12.5
|
Facility
|
OP
|
$2,910.20
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
5700533
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.12 |
| 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 |
$215.03
|
| 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 |
$873.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$436.53
|
| 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 |
$1,639.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$77.12
|
|
|
ER INT REP NEK HAND FOOT TO2.5
|
Facility
|
IP
|
$668.75
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
5700531
|
|
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 NEK HAND FOOT TO2.5
|
Facility
|
OP
|
$668.75
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
5700531
|
|
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 |
$121.97
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.72
|
|
|
ER INT REP NEK TO TRUN 12.6-20
|
Facility
|
IP
|
$737.50
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
5700530
|
|
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 NEK TO TRUN 12.6-20
|
Facility
|
OP
|
$737.50
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
5700530
|
|
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 |
$238.40
|
| 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 NEK TO TRUN 20.1-30
|
Facility
|
IP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
5700708
|
|
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 TO TRUN 20.1-30
|
Facility
|
OP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
5700708
|
|
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 |
$316.25
|
| 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 |
$1,639.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.67
|
|
|
ER INT REP NEK TO TRUN 2.5-7.5
|
Facility
|
IP
|
$687.50
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
5700528
|
|
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 TO TRUN 2.5-7.5
|
Facility
|
OP
|
$687.50
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
5700528
|
|
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 |
$153.33
|
| 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 NEK TO TRUN >30 CM
|
Facility
|
OP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
5700709
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.67 |
| Max. Negotiated Rate |
$9,062.33 |
| 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 |
$372.22
|
| 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 |
$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 |
$2,451.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$9,062.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.67
|
|
|
ER INT REP NEK TO TRUN >30 CM
|
Facility
|
IP
|
$1,723.35
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
5700709
|
|
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 TO TRUN7.6-12.5
|
Facility
|
IP
|
$718.75
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
5700529
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.81 |
| Max. Negotiated Rate |
$107.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.81
|
|
|
ER INT REP NEK TO TRUN7.6-12.5
|
Facility
|
OP
|
$718.75
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
5700529
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$19.05 |
| 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 |
$193.00
|
| 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 |
$215.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.81
|
| 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 |
$19.05
|
|
|
ER INT REP NEK TO TRUN TO 2.5
|
Facility
|
OP
|
$668.75
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
5700527
|
|
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 |
$121.97
|
| 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 TO TRUN TO 2.5
|
Facility
|
IP
|
$668.75
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
5700527
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.31 |
| Max. Negotiated Rate |
$100.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.31
|
|
|
ER INTUBATION
|
Facility
|
IP
|
$1,278.15
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
5700288
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.72 |
| Max. Negotiated Rate |
$191.72 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$191.72
|
|
|
ER INTUBATION
|
Facility
|
OP
|
$722.60
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
5700034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$1,015.70 |
| Rate for Payer: Aetna Commercial |
$765.35
|
| Rate for Payer: Aetna Medicare Advantage |
$911.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,015.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,015.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$281.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,015.70
|
| Rate for Payer: Cigna Commercial |
$564.04
|
| Rate for Payer: Cigna Medicare Advantage |
$281.38
|
| Rate for Payer: Clover Medicare Advantage |
$267.31
|
| Rate for Payer: EmblemHealth Commercial |
$844.14
|
| Rate for Payer: Humana Medicare Advantage |
$289.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$281.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$216.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.39
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$640.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.15
|
|
|
ER INTUBATION
|
Facility
|
OP
|
$1,278.15
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
5700288
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$1,015.70 |
| Rate for Payer: Aetna Commercial |
$765.35
|
| Rate for Payer: Aetna Medicare Advantage |
$911.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,015.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,015.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$281.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,015.70
|
| Rate for Payer: Cigna Commercial |
$564.04
|
| Rate for Payer: Cigna Medicare Advantage |
$281.38
|
| Rate for Payer: Clover Medicare Advantage |
$267.31
|
| Rate for Payer: EmblemHealth Commercial |
$844.14
|
| Rate for Payer: Humana Medicare Advantage |
$289.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$281.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$383.44
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$191.72
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$640.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.87
|
|
|
ER INTUBATION
|
Facility
|
IP
|
$722.60
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
5700034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.39 |
| Max. Negotiated Rate |
$108.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.39
|
|
|
ER INTUBATION PROCEDURE****
|
Facility
|
IP
|
$223.00
|
|
| Hospital Charge Code |
8004020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.45 |
| Max. Negotiated Rate |
$33.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.45
|
|
|
ER INTUBATION PROCEDURE****
|
Facility
|
OP
|
$223.00
|
|
| Hospital Charge Code |
8004020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$111.50 |
| Rate for Payer: Aetna Commercial |
$84.74
|
| Rate for Payer: Aetna Medicare Advantage |
$66.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.87
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$66.90
|
| Rate for Payer: Oxford Commercial |
$44.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.91
|
|
|
ER-IP FINGER DISLOCAT-BIL
|
Facility
|
OP
|
$612.00
|
|
| Hospital Charge Code |
5790540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare Advantage |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$156.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$156.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$156.06
|
| Rate for Payer: Cigna Commercial |
$306.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$183.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.22
|
|
