|
MULTILOC NAIL 7 X 355
|
Facility
|
OP
|
$19,405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.66 |
| Max. Negotiated Rate |
$9,702.50 |
| Rate for Payer: Aetna Commercial |
$7,373.90
|
| Rate for Payer: Aetna Medicare Advantage |
$5,821.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,948.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,948.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,881.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,948.27
|
| Rate for Payer: Cigna Commercial |
$9,702.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,696.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,269.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,910.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$467.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$514.23
|
|
|
MULTILOC NAIL 7 X 355
|
Facility
|
IP
|
$19,405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,910.75 |
| Max. Negotiated Rate |
$4,696.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,881.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,696.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,269.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,910.75
|
|
|
MULTIPLE-FAM GROUP PSYCHOTHPY
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
83246190
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$45.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.45
|
|
|
MULTIPLE-FAM GROUP PSYCHOTHPY
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
83246190
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.03
|
|
|
MULTIPLE FAMILY GROUP THERAPY
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
87506095
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.30
|
|
|
MULTIPLE FAMILY GROUP THERAPY
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
84504065
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$69.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.60
|
|
|
MULTIPLE FAMILY GROUP THERAPY
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
87506095
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$69.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.60
|
|
|
MULTIPLE FAMILY GROUP THERAPY
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
84504065
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.30
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC
|
Facility
|
IP
|
$235,451.17
|
|
|
Service Code
|
MSDRG 427
|
| Min. Negotiated Rate |
$71,691.86 |
| Max. Negotiated Rate |
$235,451.17 |
| Rate for Payer: Aetna Commercial |
$162,039.12
|
| Rate for Payer: Aetna Medicare Advantage |
$235,451.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$75,465.12
|
| Rate for Payer: Cigna Commercial |
$135,088.88
|
| Rate for Payer: Cigna Medicare Advantage |
$75,465.12
|
| Rate for Payer: Clover Medicare Advantage |
$71,691.86
|
| Rate for Payer: EmblemHealth Commercial |
$226,395.36
|
| Rate for Payer: Humana Medicare Advantage |
$77,729.07
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$75,465.12
|
| Rate for Payer: Oxford Commercial |
$97,090.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$170,250.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$75,465.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$75,465.12
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$358,357.52
|
|
|
Service Code
|
MSDRG 426
|
| Min. Negotiated Rate |
$109,115.27 |
| Max. Negotiated Rate |
$358,357.52 |
| Rate for Payer: Aetna Commercial |
$246,489.79
|
| Rate for Payer: Aetna Medicare Advantage |
$358,357.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$114,858.18
|
| Rate for Payer: Cigna Commercial |
$206,250.74
|
| Rate for Payer: Cigna Medicare Advantage |
$114,858.18
|
| Rate for Payer: Clover Medicare Advantage |
$109,115.27
|
| Rate for Payer: EmblemHealth Commercial |
$344,574.54
|
| Rate for Payer: Humana Medicare Advantage |
$118,303.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$114,858.18
|
| Rate for Payer: Oxford Commercial |
$148,235.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$259,935.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$114,858.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$114,858.18
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC
|
Facility
|
IP
|
$183,846.34
|
|
|
Service Code
|
MSDRG 428
|
| Min. Negotiated Rate |
$55,978.85 |
| Max. Negotiated Rate |
$183,846.34 |
| Rate for Payer: Aetna Commercial |
$126,580.71
|
| Rate for Payer: Aetna Medicare Advantage |
$183,846.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$58,925.11
|
| Rate for Payer: Cigna Commercial |
$105,210.11
|
| Rate for Payer: Cigna Medicare Advantage |
$58,925.11
|
| Rate for Payer: Clover Medicare Advantage |
$55,978.85
|
| Rate for Payer: EmblemHealth Commercial |
$176,775.33
|
| Rate for Payer: Humana Medicare Advantage |
$60,692.86
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$58,925.11
|
| Rate for Payer: Oxford Commercial |
$75,615.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$132,594.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$58,925.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$58,925.11
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$218,094.43
|
|
|
Service Code
|
MSDRG 447
|
| Min. Negotiated Rate |
$66,406.96 |
| Max. Negotiated Rate |
$218,094.43 |
| Rate for Payer: Aetna Commercial |
$150,113.05
|
| Rate for Payer: Aetna Medicare Advantage |
$218,094.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$69,902.06
|
| Rate for Payer: Cigna Commercial |
$125,039.46
|
| Rate for Payer: Cigna Medicare Advantage |
$69,902.06
|
| Rate for Payer: Clover Medicare Advantage |
$66,406.96
|
| Rate for Payer: EmblemHealth Commercial |
$209,706.18
|
| Rate for Payer: Humana Medicare Advantage |
$71,999.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$69,902.06
|
| Rate for Payer: Oxford Commercial |
$89,867.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$157,585.54
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$69,902.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$69,902.06
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$139,203.73
|
|
|
Service Code
|
MSDRG 448
|
| Min. Negotiated Rate |
$42,385.75 |
| Max. Negotiated Rate |
$139,203.73 |
| Rate for Payer: Aetna Commercial |
$95,906.16
|
| Rate for Payer: Aetna Medicare Advantage |
$139,203.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$44,616.58
|
| Rate for Payer: Cigna Commercial |
$79,362.33
|
| Rate for Payer: Cigna Medicare Advantage |
$44,616.58
|
| Rate for Payer: Clover Medicare Advantage |
$42,385.75
|
| Rate for Payer: EmblemHealth Commercial |
$133,849.74
|
| Rate for Payer: Humana Medicare Advantage |
$45,955.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$44,616.58
|
| Rate for Payer: Oxford Commercial |
$57,038.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$100,019.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$44,616.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$44,616.58
|
|
|
MULTIPLE SCLEROSIS 1
|
Facility
|
OP
|
$137.50
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
3036053A
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$13.46
|
| Rate for Payer: Aetna Medicare Advantage |
$16.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.87
|
| Rate for Payer: Cigna Commercial |
$68.75
|
| Rate for Payer: Cigna Medicare Advantage |
$4.95
|
| Rate for Payer: Clover Medicare Advantage |
$4.70
|
| Rate for Payer: EmblemHealth Commercial |
$14.85
|
| Rate for Payer: Humana Medicare Advantage |
$5.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.25
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.96
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.64
|
|
|
MULTIPLE SCLEROSIS 1
|
Facility
|
IP
|
$137.50
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
3036053A
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$20.62 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.62
|
|
|
MULTIPLE SCLEROSIS 2
|
Facility
|
OP
|
$47.50
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
3036053B
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare Advantage |
$25.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.08
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: Cigna Medicare Advantage |
$7.78
|
| Rate for Payer: Clover Medicare Advantage |
$7.39
|
| Rate for Payer: EmblemHealth Commercial |
$23.34
|
| Rate for Payer: Humana Medicare Advantage |
$8.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.25
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.26
|
|
|
MULTIPLE SCLEROSIS 2
|
Facility
|
IP
|
$47.50
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
3036053B
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$7.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
|
|
MULTIPLE SCLEROSIS 3
|
Facility
|
IP
|
$81.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3036053C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$12.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.19
|
|
|
MULTIPLE SCLEROSIS 3
|
Facility
|
OP
|
$81.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3036053C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.57
|
| Rate for Payer: Cigna Commercial |
$40.62
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.38
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
MULTIPLE SCLEROSIS 4
|
Facility
|
IP
|
$181.65
|
|
|
Service Code
|
HCPCS 83916
|
| Hospital Charge Code |
3036053D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$27.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.25
|
|
|
MULTIPLE SCLEROSIS 4
|
Facility
|
OP
|
$181.65
|
|
|
Service Code
|
HCPCS 83916
|
| Hospital Charge Code |
3036053D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$74.50
|
| Rate for Payer: Aetna Medicare Advantage |
$88.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$98.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$98.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$27.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$42.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$98.87
|
| Rate for Payer: Cigna Commercial |
$90.83
|
| Rate for Payer: Cigna Medicare Advantage |
$27.39
|
| Rate for Payer: Clover Medicare Advantage |
$26.02
|
| Rate for Payer: EmblemHealth Commercial |
$82.17
|
| Rate for Payer: Humana Medicare Advantage |
$28.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$27.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$27.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.81
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC
|
Facility
|
IP
|
$42,242.02
|
|
|
Service Code
|
MSDRG 059
|
| Min. Negotiated Rate |
$12,862.15 |
| Max. Negotiated Rate |
$42,242.02 |
| Rate for Payer: Aetna Medicare Advantage |
$42,242.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27,680.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27,680.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13,539.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27,680.59
|
| Rate for Payer: Cigna Commercial |
$23,222.20
|
| Rate for Payer: Cigna Medicare Advantage |
$13,539.11
|
| Rate for Payer: Clover Medicare Advantage |
$12,862.15
|
| Rate for Payer: EmblemHealth Commercial |
$40,617.33
|
| Rate for Payer: Humana Medicare Advantage |
$13,945.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13,539.11
|
| Rate for Payer: Oxford Commercial |
$16,690.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$29,266.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13,539.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$13,539.11
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC
|
Facility
|
IP
|
$57,387.94
|
|
|
Service Code
|
MSDRG 058
|
| Min. Negotiated Rate |
$17,473.89 |
| Max. Negotiated Rate |
$57,387.94 |
| Rate for Payer: Aetna Medicare Advantage |
$57,387.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40,241.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40,241.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18,393.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40,241.53
|
| Rate for Payer: Cigna Commercial |
$31,991.58
|
| Rate for Payer: Cigna Medicare Advantage |
$18,393.57
|
| Rate for Payer: Clover Medicare Advantage |
$17,473.89
|
| Rate for Payer: EmblemHealth Commercial |
$55,180.71
|
| Rate for Payer: Humana Medicare Advantage |
$18,945.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18,393.57
|
| Rate for Payer: Oxford Commercial |
$22,992.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$40,318.56
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18,393.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$18,393.57
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC
|
Facility
|
IP
|
$31,863.56
|
|
|
Service Code
|
MSDRG 060
|
| Min. Negotiated Rate |
$9,702.05 |
| Max. Negotiated Rate |
$31,863.56 |
| Rate for Payer: Aetna Medicare Advantage |
$31,863.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20,934.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20,934.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10,212.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20,934.90
|
| Rate for Payer: Cigna Commercial |
$17,213.14
|
| Rate for Payer: Cigna Medicare Advantage |
$10,212.68
|
| Rate for Payer: Clover Medicare Advantage |
$9,702.05
|
| Rate for Payer: EmblemHealth Commercial |
$30,638.04
|
| Rate for Payer: Humana Medicare Advantage |
$10,519.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10,212.68
|
| Rate for Payer: Oxford Commercial |
$12,371.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$21,693.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10,212.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$10,212.68
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$39,465.62
|
|
|
Service Code
|
APR-DRG 0434
|
| Min. Negotiated Rate |
$38,691.78 |
| Max. Negotiated Rate |
$39,465.62 |
| Rate for Payer: UnitedHealthcare Community & State |
$38,691.78
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$39,465.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38,691.78
|
|
