|
ER-REDUCE TESTIS TORSION
|
Facility
|
OP
|
$6,905.00
|
|
|
Service Code
|
HCPCS 54600
|
| Hospital Charge Code |
5790185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$15,116.59 |
| Rate for Payer: Aetna Commercial |
$11,390.73
|
| Rate for Payer: Aetna Medicare Advantage |
$13,568.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,116.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,116.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,187.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$327.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15,116.59
|
| Rate for Payer: Cigna Commercial |
$8,394.37
|
| Rate for Payer: Cigna Medicare Advantage |
$4,187.77
|
| Rate for Payer: Clover Medicare Advantage |
$3,978.38
|
| Rate for Payer: EmblemHealth Commercial |
$12,563.31
|
| Rate for Payer: Humana Medicare Advantage |
$4,313.40
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,187.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,071.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,035.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,187.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,187.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$182.98
|
|
|
ER-REDUCE TESTIS TORSION
|
Facility
|
IP
|
$6,905.00
|
|
|
Service Code
|
HCPCS 54600
|
| Hospital Charge Code |
5790185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,035.75 |
| Max. Negotiated Rate |
$1,035.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,035.75
|
|
|
ER REDUCT TOE MP DISC W/O ANES
|
Facility
|
IP
|
$1,175.15
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
5700772
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.27 |
| Max. Negotiated Rate |
$176.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.27
|
|
|
ER REDUCT TOE MP DISC W/O ANES
|
Facility
|
OP
|
$1,175.15
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
5700772
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.14 |
| 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 |
$118.10
|
| 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 |
$352.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.27
|
| 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 |
$31.14
|
|
|
ER REGIONAL BLOCK
|
Facility
|
OP
|
$1,398.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
5700804
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$1,316.35 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,316.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$73.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,316.35
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$419.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$209.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.05
|
|
|
ER REGIONAL BLOCK
|
Facility
|
IP
|
$1,398.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
5700804
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$209.70 |
| Max. Negotiated Rate |
$209.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$209.70
|
|
|
ER REM FB CONJUNCTIVA SUPERFAL
|
Facility
|
IP
|
$528.85
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
5700418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.33 |
| Max. Negotiated Rate |
$79.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.33
|
|
|
ER REM FB CONJUNCTIVA SUPERFAL
|
Facility
|
OP
|
$528.85
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
5700418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.01 |
| 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 |
$43.37
|
| 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 |
$158.66
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.33
|
| 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: Wellpoint Medicaid Managed Care |
$14.01
|
|
|
ER REM FB OUTER EAR CAN W/O AN
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
5700500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.62 |
| 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 |
$35.24
|
| 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 |
$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 |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.62
|
|
|
ER REM FB OUTER EAR CAN W/O AN
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
5700500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
ER REM FOREIGN BODY, SUBQ FOOT
|
Facility
|
IP
|
$1,603.75
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
5700470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.56 |
| Max. Negotiated Rate |
$240.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$240.56
|
|
|
ER REM FOREIGN BODY, SUBQ FOOT
|
Facility
|
OP
|
$1,603.75
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
5700470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.50 |
| 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 |
$73.18
|
| 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 |
$481.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$240.56
|
| 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 |
$42.50
|
|
|
ER-REM NAIL/FINGER TIP-BI
|
Facility
|
OP
|
$7,260.00
|
|
|
Service Code
|
HCPCS 11752
|
| Hospital Charge Code |
5790275
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,758.80
|
| Rate for Payer: Aetna Medicare Advantage |
$2,178.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,851.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,851.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,851.30
|
| Rate for Payer: Cigna Commercial |
$3,630.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,089.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$192.39
|
|
|
ER-REM NAIL/FINGER TIP-BI
|
Facility
|
IP
|
$7,260.00
|
|
|
Service Code
|
HCPCS 11752
|
| Hospital Charge Code |
5790275
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,089.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,089.00
|
|
|
ER REM OF EMBEDDED FB EYELID
|
Facility
|
OP
|
$673.75
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
5700673
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$1,361.18 |
| Rate for Payer: Aetna Commercial |
$1,025.68
|
| Rate for Payer: Aetna Medicare Advantage |
$1,221.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,361.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,361.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$377.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$63.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,361.18
|
| Rate for Payer: Cigna Commercial |
$755.86
|
| Rate for Payer: Cigna Medicare Advantage |
$377.09
|
| Rate for Payer: Clover Medicare Advantage |
$358.24
|
| Rate for Payer: EmblemHealth Commercial |
$1,131.27
|
| Rate for Payer: Humana Medicare Advantage |
$388.40
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$377.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.06
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$377.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$377.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.85
|
|
|
ER REM OF EMBEDDED FB EYELID
|
Facility
|
IP
|
$673.75
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
5700673
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.06 |
| Max. Negotiated Rate |
$101.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.06
|
|
|
ER REMOVAL CAST FULL ARM/LEG L
|
Facility
|
IP
|
$348.75
|
|
|
Service Code
|
HCPCS 29705LT
|
| Hospital Charge Code |
5700619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$52.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.31
|
|
|
ER REMOVAL CAST FULL ARM/LEG L
|
Facility
|
OP
|
$348.75
|
|
|
Service Code
|
HCPCS 29705LT
|
| Hospital Charge Code |
5700619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$132.53
|
| Rate for Payer: Aetna Medicare Advantage |
$104.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$88.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$88.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$88.93
|
| Rate for Payer: Cigna Commercial |
$174.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.24
|
|
|
ER REMOVAL CAST FULL ARM/LEG R
|
Facility
|
OP
|
$348.75
|
|
|
Service Code
|
HCPCS 29705RT
|
| Hospital Charge Code |
5700618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$132.53
|
| Rate for Payer: Aetna Medicare Advantage |
$104.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$88.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$88.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$88.93
|
| Rate for Payer: Cigna Commercial |
$174.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.24
|
|
|
ER REMOVAL CAST FULL ARM/LEG R
|
Facility
|
IP
|
$348.75
|
|
|
Service Code
|
HCPCS 29705RT
|
| Hospital Charge Code |
5700618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$52.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.31
|
|
|
ER REMOVAL FB NASAL
|
Facility
|
OP
|
$452.22
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
5700439
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.98 |
| 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 |
$43.37
|
| 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 |
$135.67
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.83
|
| 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: Wellpoint Medicaid Managed Care |
$11.98
|
|
|
ER REMOVAL FB NASAL
|
Facility
|
IP
|
$452.22
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
5700439
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.83 |
| Max. Negotiated Rate |
$67.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.83
|
|
|
ER REMOVAL FB PHARYNX
|
Facility
|
IP
|
$201.25
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
5700649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$30.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.19
|
|
|
ER REMOVAL FB PHARYNX
|
Facility
|
OP
|
$201.25
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
5700649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.33 |
| 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 |
$140.69
|
| 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 |
$60.38
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.19
|
| 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 |
$5.33
|
|
|
ER REMOVAL INTRAURINE DEVICE
|
Facility
|
IP
|
$1,621.70
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
5701004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.25 |
| Max. Negotiated Rate |
$243.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.25
|
|
