|
INTERP THORACIC MYELOGRAM
|
Facility
|
OP
|
$2,963.00
|
|
|
Service Code
|
HCPCS 72255
|
| Hospital Charge Code |
84506075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.41 |
| Max. Negotiated Rate |
$3,361.79 |
| Rate for Payer: Aetna Commercial |
$2,533.19
|
| Rate for Payer: Aetna Medicare Advantage |
$3,017.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,361.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,361.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$931.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$108.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,361.79
|
| Rate for Payer: Cigna Commercial |
$1,866.82
|
| Rate for Payer: Cigna Medicare Advantage |
$651.92
|
| Rate for Payer: Clover Medicare Advantage |
$884.75
|
| Rate for Payer: EmblemHealth Commercial |
$2,793.96
|
| Rate for Payer: Humana Medicare Advantage |
$959.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$931.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$888.90
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$444.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.41
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$931.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$931.32
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,627.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$78.52
|
|
|
INTERPULSE HANDPIECE W/HI FLOW
|
Facility
|
IP
|
$197.98
|
|
| Hospital Charge Code |
270668406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
|
|
INTERPULSE HANDPIECE W/HI FLOW
|
Facility
|
OP
|
$197.98
|
|
| Hospital Charge Code |
270668406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$98.99 |
| Rate for Payer: Aetna Commercial |
$75.23
|
| Rate for Payer: Aetna Medicare Advantage |
$59.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$50.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$50.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$50.48
|
| Rate for Payer: Cigna Commercial |
$98.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.39
|
| Rate for Payer: Oxford Commercial |
$39.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$39.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.25
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
IP
|
$301.65
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
5300165
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$45.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.25
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
OP
|
$301.65
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
5300165
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Medicare Advantage |
$143.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$44.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.05
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: Cigna Medicare Advantage |
$44.34
|
| Rate for Payer: Clover Medicare Advantage |
$42.12
|
| Rate for Payer: EmblemHealth Commercial |
$133.02
|
| Rate for Payer: Humana Medicare Advantage |
$45.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$44.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.50
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.99
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
OP
|
$301.65
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
94053090
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Medicare Advantage |
$143.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$44.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.05
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: Cigna Medicare Advantage |
$44.34
|
| Rate for Payer: Clover Medicare Advantage |
$42.12
|
| Rate for Payer: EmblemHealth Commercial |
$133.02
|
| Rate for Payer: Humana Medicare Advantage |
$45.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$44.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.50
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.99
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
OP
|
$214.68
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
74115022
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Medicare Advantage |
$143.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$44.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.05
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: Cigna Medicare Advantage |
$44.34
|
| Rate for Payer: Clover Medicare Advantage |
$42.12
|
| Rate for Payer: EmblemHealth Commercial |
$133.02
|
| Rate for Payer: Humana Medicare Advantage |
$45.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$44.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.40
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.17
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.69
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
OP
|
$214.68
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
74117022
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Medicare Advantage |
$143.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$44.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.05
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: Cigna Medicare Advantage |
$44.34
|
| Rate for Payer: Clover Medicare Advantage |
$42.12
|
| Rate for Payer: EmblemHealth Commercial |
$133.02
|
| Rate for Payer: Humana Medicare Advantage |
$45.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$44.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.40
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.17
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.69
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
IP
|
$301.65
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
94053090
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$45.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.25
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
IP
|
$214.68
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
74115022
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.20
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
IP
|
$214.68
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
74116022
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.20
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
OP
|
$214.68
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
74116022
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Medicare Advantage |
$143.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$44.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.05
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: Cigna Medicare Advantage |
$44.34
|
| Rate for Payer: Clover Medicare Advantage |
$42.12
|
| Rate for Payer: EmblemHealth Commercial |
$133.02
|
| Rate for Payer: Humana Medicare Advantage |
$45.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$44.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.40
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.17
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.69
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
IP
|
$214.68
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
74117022
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.20
|
|
|
INTER SCREW12X28 FULL THREAD
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
INTER SCREW12X28 FULL THREAD
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
INTERSPACE FOR KNEE LARGE 74mm
|
Facility
|
OP
|
$21,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270680018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.14 |
| Max. Negotiated Rate |
$10,687.50 |
| Rate for Payer: Aetna Commercial |
$8,122.50
|
| Rate for Payer: Aetna Medicare Advantage |
$6,412.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,450.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,450.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,450.62
|
| Rate for Payer: Cigna Commercial |
$10,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,172.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,702.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,206.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$515.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$566.44
|
|
|
INTERSPACE FOR KNEE LARGE 74mm
|
Facility
|
IP
|
$21,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270680018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,206.25 |
| Max. Negotiated Rate |
$5,172.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,172.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,702.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,206.25
|
|
|
INTERSTIM I CON PROGRAMMER
|
Facility
|
IP
|
$9,750.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
270685083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.50 |
| Max. Negotiated Rate |
$2,359.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,359.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,462.50
|
|
|
INTERSTIM I CON PROGRAMMER
|
Facility
|
OP
|
$9,750.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
270685083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.97 |
| Max. Negotiated Rate |
$4,875.00 |
| Rate for Payer: Aetna Commercial |
$3,705.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,486.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,486.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,486.25
|
| Rate for Payer: Cigna Commercial |
$4,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,359.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,462.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$234.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$258.38
|
|
|
INTERSTIM X SSMRI 97800
|
Facility
|
IP
|
$58,400.00
|
|
|
Service Code
|
HCPCS L8679
|
| Hospital Charge Code |
270695516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,760.00 |
| Max. Negotiated Rate |
$14,132.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11,680.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14,132.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$12,848.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,760.00
|
|
|
INTERSTIM X SSMRI 97800
|
Facility
|
OP
|
$58,400.00
|
|
|
Service Code
|
HCPCS L8679
|
| Hospital Charge Code |
270695516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,407.44 |
| Max. Negotiated Rate |
$29,200.00 |
| Rate for Payer: Aetna Commercial |
$22,192.00
|
| Rate for Payer: Aetna Medicare Advantage |
$17,520.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,892.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,892.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11,680.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14,892.00
|
| Rate for Payer: Cigna Commercial |
$29,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14,132.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$12,848.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,407.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,547.60
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$8,977.80
|
|
|
Service Code
|
APR-DRG 1422
|
| Min. Negotiated Rate |
$8,801.76 |
| Max. Negotiated Rate |
$8,977.80 |
| Rate for Payer: UnitedHealthcare Community & State |
$8,801.76
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$8,977.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8,801.76
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$7,628.36
|
|
|
Service Code
|
APR-DRG 1421
|
| Min. Negotiated Rate |
$7,478.78 |
| Max. Negotiated Rate |
$7,628.36 |
| Rate for Payer: UnitedHealthcare Community & State |
$7,478.78
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$7,628.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7,478.78
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$22,401.11
|
|
|
Service Code
|
APR-DRG 1424
|
| Min. Negotiated Rate |
$21,961.87 |
| Max. Negotiated Rate |
$22,401.11 |
| Rate for Payer: UnitedHealthcare Community & State |
$21,961.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$22,401.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21,961.87
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$13,042.86
|
|
|
Service Code
|
APR-DRG 1423
|
| Min. Negotiated Rate |
$12,787.12 |
| Max. Negotiated Rate |
$13,042.86 |
| Rate for Payer: UnitedHealthcare Community & State |
$12,787.12
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$13,042.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12,787.12
|
|
