|
APPLICATION LONG ARM SPLINT
|
Facility
|
OP
|
$348.85
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
2500370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$696.85 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Medicare Advantage |
$625.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$696.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$696.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$193.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$72.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$696.85
|
| Rate for Payer: Cigna Commercial |
$386.97
|
| Rate for Payer: Cigna Medicare Advantage |
$193.05
|
| Rate for Payer: Clover Medicare Advantage |
$183.40
|
| Rate for Payer: EmblemHealth Commercial |
$579.15
|
| Rate for Payer: Humana Medicare Advantage |
$198.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$193.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.66
|
| Rate for Payer: Oxford Commercial |
$69.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$69.77
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.41
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.24
|
|
|
APPLICATION LONG ARM SPLINT
|
Facility
|
IP
|
$348.85
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
2500370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.33 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.33
|
|
|
APPLICATION LONG LEG CAST
|
Facility
|
OP
|
$1,360.45
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
412329345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.79 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$1,355.00
|
| 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 |
$408.13
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.05
|
|
|
APPLICATION LONG LEG CAST
|
Facility
|
IP
|
$1,360.45
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
412329345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.07 |
| Max. Negotiated Rate |
$204.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.07
|
|
|
APPLICATION LONG LEG SPLIT -R
|
Facility
|
OP
|
$1,190.20
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
1600000472
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Medicare Advantage |
$625.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$696.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$696.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$193.05
|
| 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 |
$696.85
|
| Rate for Payer: Cigna Commercial |
$386.97
|
| Rate for Payer: Cigna Medicare Advantage |
$193.05
|
| Rate for Payer: Clover Medicare Advantage |
$183.40
|
| Rate for Payer: EmblemHealth Commercial |
$579.15
|
| Rate for Payer: Humana Medicare Advantage |
$198.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$193.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$357.06
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$178.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.54
|
|
|
APPLICATION LONG LEG SPLIT -R
|
Facility
|
IP
|
$1,190.20
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
1600000472
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.53 |
| Max. Negotiated Rate |
$178.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$178.53
|
|
|
APPLICATION OF BODY CAST
|
Facility
|
IP
|
$1,360.45
|
|
|
Service Code
|
HCPCS 29035
|
| Hospital Charge Code |
412329035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.07 |
| Max. Negotiated Rate |
$204.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.07
|
|
|
APPLICATION OF BODY CAST
|
Facility
|
OP
|
$1,360.45
|
|
|
Service Code
|
HCPCS 29035
|
| Hospital Charge Code |
412329035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.79 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$1,626.00
|
| 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 |
$408.13
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.05
|
|
|
APPLICATION OF FINGER SPLINT; STATIC
|
Facility
|
OP
|
$2,220.00
|
|
|
Service Code
|
CPT 29130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$150.16 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$1,626.00
|
| 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: Oxford Commercial |
$1,487.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
OP
|
$1,676.25
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
1600000818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$1,626.00
|
| 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 |
$502.88
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$251.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$40.40
|
| 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 |
$1,443.93
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
IP
|
$1,391.15
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
412329075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.67 |
| Max. Negotiated Rate |
$208.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$208.67
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
OP
|
$1,391.15
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
412329075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$33.53 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$1,626.00
|
| 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: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$208.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.53
|
| 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 |
$1,443.93
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
IP
|
$1,676.25
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
1600000818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$251.44 |
| Max. Negotiated Rate |
$251.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$251.44
|
|
|
APPLICATION OF HIP CAST
|
Facility
|
IP
|
$1,360.45
|
|
|
Service Code
|
HCPCS 29305
|
| Hospital Charge Code |
412329305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.07 |
| Max. Negotiated Rate |
$204.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.07
|
|
|
APPLICATION OF HIP CAST
|
Facility
|
OP
|
$1,360.45
|
|
|
Service Code
|
HCPCS 29305
|
| Hospital Charge Code |
412329305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.79 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$1,626.00
|
| 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 |
$408.13
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.05
|
|
|
APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
|
Facility
|
OP
|
$2,220.00
|
|
|
Service Code
|
CPT 29105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Medicare Advantage |
$625.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$696.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$696.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$193.05
|
| 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 |
$696.85
|
| Rate for Payer: Cigna Commercial |
$386.97
|
| Rate for Payer: Cigna Medicare Advantage |
$193.05
|
| Rate for Payer: Clover Medicare Advantage |
$183.40
|
| Rate for Payer: EmblemHealth Commercial |
$579.15
|
| Rate for Payer: Humana Medicare Advantage |
$198.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$193.05
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.05
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
IP
|
$1,563.80
|
|
|
Service Code
|
HCPCS 29365
|
| Hospital Charge Code |
1600000357
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$234.57 |
| Max. Negotiated Rate |
$234.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$234.57
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$1,563.80
|
|
|
Service Code
|
HCPCS 29365
|
| Hospital Charge Code |
1600000357
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$37.69 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$1,626.00
|
| 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 |
$469.14
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$234.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$37.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.44
|
|
|
APPLICATION SHORT LEG CAST
|
Facility
|
IP
|
$1,360.45
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
412329405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.07 |
| Max. Negotiated Rate |
$204.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.07
|
|
|
APPLICATION SHORT LEG CAST
|
Facility
|
OP
|
$1,360.45
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
412329405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.79 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$1,626.00
|
| 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 |
$408.13
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.05
|
|
|
APPLICATOR COTTON TIP 3
|
Facility
|
IP
|
$420.00
|
|
| Hospital Charge Code |
270300050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
|
|
APPLICATOR COTTON TIP 3
|
Facility
|
OP
|
$420.00
|
|
| Hospital Charge Code |
270300050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.10
|
| Rate for Payer: Cigna Commercial |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$126.00
|
| Rate for Payer: Oxford Commercial |
$84.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$84.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.13
|
|
|
APPLICATOR COTTON TIP 6 STRL
|
Facility
|
OP
|
$0.10
|
|
| Hospital Charge Code |
270300060
|
|
Hospital Revenue Code
|
272
|
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare Advantage |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.03
|
| Rate for Payer: Oxford Commercial |
$0.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.02
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
APPLICATOR COTTON TIP 6 STRL
|
Facility
|
IP
|
$0.10
|
|
| Hospital Charge Code |
270300060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.02
|
|
|
APPLICATOR ENDOSCOPIC 360
|
Facility
|
OP
|
$3,278.20
|
|
| Hospital Charge Code |
270680888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$1,639.10 |
| Rate for Payer: Aetna Commercial |
$1,245.72
|
| Rate for Payer: Aetna Medicare Advantage |
$983.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$835.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$835.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$835.94
|
| Rate for Payer: Cigna Commercial |
$1,639.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$983.46
|
| Rate for Payer: Oxford Commercial |
$655.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$491.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$655.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$79.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$86.87
|
|
