|
ER SHORT ARM CAST
|
Facility
|
OP
|
$1,391.15
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
5700773
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.87 |
| Max. Negotiated Rate |
$1,472.81 |
| Rate for Payer: Aetna Commercial |
$903.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,076.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,199.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,199.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$332.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,199.43
|
| Rate for Payer: Cigna Commercial |
$666.07
|
| Rate for Payer: Cigna Medicare Advantage |
$332.28
|
| Rate for Payer: Clover Medicare Advantage |
$315.67
|
| Rate for Payer: EmblemHealth Commercial |
$996.84
|
| Rate for Payer: Humana Medicare Advantage |
$342.25
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$332.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$417.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$208.67
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,472.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.87
|
|
|
ER SHORT ARM CAST
|
Facility
|
IP
|
$1,391.15
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
5700773
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$208.67 |
| Max. Negotiated Rate |
$208.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$208.67
|
|
|
ER-SHOULD DISLO W/FX-BI
|
Facility
|
IP
|
$498.00
|
|
| Hospital Charge Code |
5790360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.70
|
|
|
ER-SHOULD DISLO W/FX-BI
|
Facility
|
OP
|
$498.00
|
|
| Hospital Charge Code |
5790360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$189.24
|
| Rate for Payer: Aetna Medicare Advantage |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$126.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.99
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$149.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.20
|
|
|
ER-SHOULDER DISLOCAT-BILA
|
Facility
|
IP
|
$612.00
|
|
| Hospital Charge Code |
5790350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
|
|
ER-SHOULDER DISLOCAT-BILA
|
Facility
|
OP
|
$612.00
|
|
| Hospital Charge Code |
5790350
|
|
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
|
|
|
ER SIMPLE WOUND DEHISCE REPAIR
|
Facility
|
IP
|
$980.51
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
5700706
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$147.08 |
| Max. Negotiated Rate |
$147.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.08
|
|
|
ER SIMPLE WOUND DEHISCE REPAIR
|
Facility
|
OP
|
$980.51
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
5700706
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.98 |
| 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 |
$200.03
|
| 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 |
$294.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.08
|
| 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 |
$25.98
|
|
|
ER SIM REP FACE 12.6-20
|
Facility
|
IP
|
$3,189.20
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
5700524
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.38 |
| Max. Negotiated Rate |
$478.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$478.38
|
|
|
ER SIM REP FACE 12.6-20
|
Facility
|
OP
|
$3,189.20
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
5700524
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.51 |
| 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 |
$253.62
|
| 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 |
$956.76
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$478.38
|
| 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 |
$84.51
|
|
|
ER SIM REP FACE 20.1-30
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
5700525
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$405.00
|
|
|
ER SIM REP FACE 20.1-30
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
5700525
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.55 |
| 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 |
$223.53
|
| 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 |
$810.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$405.00
|
| 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 |
$71.55
|
|
|
ER SIM REP FACE 2.6-5
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
5700521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
ER SIM REP FACE 2.6-5
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
5700521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$860.41 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.41
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$554.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.26
|
|
|
ER SIM REP FACE 5.1-7.5
|
Facility
|
IP
|
$432.50
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
5700522
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$64.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.88
|
|
|
ER SIM REP FACE 5.1-7.5
|
Facility
|
OP
|
$432.50
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
5700522
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$860.41 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| 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 |
$860.41
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.46
|
|
|
ER SIM REP FACE 7.6-12.5
|
Facility
|
OP
|
$438.75
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
5700523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$860.41 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.41
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$131.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.81
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.63
|
|
|
ER SIM REP FACE 7.6-12.5
|
Facility
|
IP
|
$438.75
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
5700523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.81 |
| Max. Negotiated Rate |
$65.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.81
|
|
|
ER SIM REP FACE OVER 30
|
Facility
|
OP
|
$562.50
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
5700526
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$860.41 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$276.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.41
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$168.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.91
|
|
|
ER SIM REP FACE OVER 30
|
Facility
|
IP
|
$562.50
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
5700526
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.38
|
|
|
ER SIM REP FACE UPTO 2.5
|
Facility
|
IP
|
$3,286.55
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
5700520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$492.98 |
| Max. Negotiated Rate |
$492.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$492.98
|
|
|
ER SIM REP FACE UPTO 2.5
|
Facility
|
OP
|
$3,286.55
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
5700520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$985.97 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| 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 |
$860.41
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$985.97
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$492.98
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$87.09
|
|
|
ER SIM REP NCK TO TRUN OVER 30
|
Facility
|
IP
|
$562.50
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
5700519
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.38
|
|
|
ER SIM REP NCK TO TRUN OVER 30
|
Facility
|
OP
|
$562.50
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
5700519
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$860.41 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$271.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.41
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$168.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.91
|
|
|
ER SIM REP NEK TO TRUN20.1-30
|
Facility
|
OP
|
$532.50
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
5700518
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.11 |
| 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 |
$239.52
|
| 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 |
$159.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.88
|
| 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 |
$14.11
|
|
