|
UNLSTD PROCEDURE LEG OR ANKLE
|
Facility
|
OP
|
$859.60
|
|
|
Service Code
|
HCPCS 27899
|
| Hospital Charge Code |
16000415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$1,626.00
|
| 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 |
$257.88
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.78
|
|
|
UNLSTD PROCEDURE LUNGS&PLEURA
|
Facility
|
OP
|
$2,450.28
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
1600000513
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$59.05 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| 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 |
$2,690.13
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$745.25
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$735.08
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$367.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$64.93
|
|
|
UNLSTD PROCEDURE LUNGS&PLEURA
|
Facility
|
IP
|
$2,450.28
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
1600000513
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.54 |
| Max. Negotiated Rate |
$367.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$367.54
|
|
|
UNLSTD PROCEDURE,NERVOUS-SYSTM
|
Facility
|
IP
|
$5,954.30
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
160000243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$893.14 |
| Max. Negotiated Rate |
$893.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$893.14
|
|
|
UNLSTD PROCEDURE,NERVOUS-SYSTM
|
Facility
|
OP
|
$5,954.30
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
160000243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$1,626.00
|
| 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 |
$1,786.29
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$893.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$143.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$157.79
|
|
|
UNLSTD PROCEDURE UNARY SYSTEM
|
Facility
|
OP
|
$918.12
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
16000460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| 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 |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.44
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$137.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.33
|
|
|
UNLSTD PROCEDURE UNARY SYSTEM
|
Facility
|
IP
|
$918.12
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
16000460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.72 |
| Max. Negotiated Rate |
$137.72 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$137.72
|
|
|
UNLSTD PROC FEMALE GENITAL SYS
|
Facility
|
OP
|
$642.80
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
16001011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$653.29
|
| Rate for Payer: Aetna Medicare Advantage |
$778.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$866.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$866.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$240.18
|
| 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 |
$866.98
|
| Rate for Payer: Cigna Commercial |
$481.45
|
| Rate for Payer: Cigna Medicare Advantage |
$240.18
|
| Rate for Payer: Clover Medicare Advantage |
$228.17
|
| Rate for Payer: EmblemHealth Commercial |
$720.54
|
| Rate for Payer: Humana Medicare Advantage |
$247.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$240.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$192.84
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.03
|
|
|
UNLSTD PROC FEMALE GENITAL SYS
|
Facility
|
IP
|
$642.80
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
16001011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.42
|
|
|
UNLSTD PROC SKIN MM & SQ TISS
|
Facility
|
IP
|
$5,068.40
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
16000262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$760.26 |
| Max. Negotiated Rate |
$760.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$760.26
|
|
|
UNLSTD PROC SKIN MM & SQ TISS
|
Facility
|
OP
|
$5,068.40
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
16000262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$122.15 |
| Max. Negotiated Rate |
$2,220.00 |
| 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 |
$1,626.00
|
| 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 |
$1,520.52
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$760.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$134.31
|
|
|
UNLST PROC MATERNITY CARE&DEL
|
Facility
|
OP
|
$642.80
|
|
|
Service Code
|
HCPCS 59899
|
| Hospital Charge Code |
16001015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$653.29
|
| Rate for Payer: Aetna Medicare Advantage |
$778.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$866.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$866.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$240.18
|
| 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 |
$866.98
|
| Rate for Payer: Cigna Commercial |
$481.45
|
| Rate for Payer: Cigna Medicare Advantage |
$240.18
|
| Rate for Payer: Clover Medicare Advantage |
$228.17
|
| Rate for Payer: EmblemHealth Commercial |
$720.54
|
| Rate for Payer: Humana Medicare Advantage |
$247.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$240.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$192.84
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.03
|
|
|
UNLST PROC MATERNITY CARE&DEL
|
Facility
|
IP
|
$642.80
|
|
|
Service Code
|
HCPCS 59899
|
| Hospital Charge Code |
16001015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.42
|
|
|
UNNA BOOT 4
|
Facility
|
IP
|
$5.85
|
|
|
Service Code
|
HCPCS A6456
|
| Hospital Charge Code |
9808106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.88
|
|
|
UNNA BOOT 4
|
Facility
|
OP
|
$5.85
|
|
|
Service Code
|
HCPCS A6456
|
| Hospital Charge Code |
9808106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna Medicare Advantage |
$1.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.49
|
| Rate for Payer: Cigna Commercial |
$2.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.75
|
| Rate for Payer: Oxford Commercial |
$1.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.16
|
|
|
UNNA BOOT 4X10YD
|
Facility
|
IP
|
$27.48
|
|
| Hospital Charge Code |
270653063
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.12
|
|
|
UNNA BOOT 4X10YD
|
Facility
|
OP
|
$27.48
|
|
| Hospital Charge Code |
270653063
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$13.74 |
| Rate for Payer: Aetna Commercial |
$10.44
|
| Rate for Payer: Aetna Medicare Advantage |
$8.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.01
|
| Rate for Payer: Cigna Commercial |
$13.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.24
|
| Rate for Payer: Oxford Commercial |
$5.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.73
|
|
|
UNNA BOOT APPLICATION
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
421029580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.40
|
|
|
UNNA BOOT APPLICATION
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
9108030
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
UNNA BOOT APPLICATION
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
421029580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.47 |
| 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 |
$56.40
|
| 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 |
$142.80
|
| Rate for Payer: Oxford Commercial |
$95.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$95.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.47
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.61
|
|
|
UNNA BOOT APPLICATION
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
9108030
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$1,060.00 |
| 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 |
$116.00
|
| 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 |
$135.13
|
| 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 |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
UNNA BOOT PRIMER 4 MODIFIED
|
Facility
|
OP
|
$11.50
|
|
| Hospital Charge Code |
60629869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna Commercial |
$4.37
|
| Rate for Payer: Aetna Medicare Advantage |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.93
|
| Rate for Payer: Cigna Commercial |
$5.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.45
|
| Rate for Payer: Oxford Commercial |
$2.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.30
|
|
|
UNNA BOOT PRIMER 4 MODIFIED
|
Facility
|
IP
|
$11.50
|
|
| Hospital Charge Code |
60629869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.73
|
|
|
UNSCHED DIALYSIS ESRD PT HOS
|
Facility
|
OP
|
$3,624.15
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
93626001
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$87.34 |
| Max. Negotiated Rate |
$4,468.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,943.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,943.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$815.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,943.20
|
| Rate for Payer: Cigna Commercial |
$1,634.39
|
| Rate for Payer: Clover Medicare Advantage |
$774.59
|
| Rate for Payer: EmblemHealth Commercial |
$2,446.08
|
| Rate for Payer: Humana Medicare Advantage |
$839.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$815.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,087.24
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$700.00
|
| Rate for Payer: Oxford Commercial |
$2,546.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,468.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$87.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$815.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$815.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.04
|
|
|
UNSCHED DIALYSIS ESRD PT HOS
|
Facility
|
IP
|
$3,624.15
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
93626001
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$543.62 |
| Max. Negotiated Rate |
$543.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.62
|
|
