|
DX ER FINGER LT 4TH DIGIT
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F3
|
| Hospital Charge Code |
94270175
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
|
|
DX ER FINGER LT 5TH DIGIT
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F4
|
| Hospital Charge Code |
94270177
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
|
|
DX ER FINGER LT 5TH DIGIT
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F4
|
| Hospital Charge Code |
94270177
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$75.30
|
| Rate for Payer: Aetna Medicare Advantage |
$75.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.00
|
| Rate for Payer: Cigna Commercial |
$125.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.63
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
DX ER FINGER LT THUMB
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140FA
|
| Hospital Charge Code |
94270189
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$75.30
|
| Rate for Payer: Aetna Medicare Advantage |
$75.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.00
|
| Rate for Payer: Cigna Commercial |
$125.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.63
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
DX ER FINGER LT THUMB
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140FA
|
| Hospital Charge Code |
94270189
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
|
|
DX ER FINGER RT 2ND DIGIT
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F6
|
| Hospital Charge Code |
94270181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
|
|
DX ER FINGER RT 2ND DIGIT
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F6
|
| Hospital Charge Code |
94270181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$75.30
|
| Rate for Payer: Aetna Medicare Advantage |
$75.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.00
|
| Rate for Payer: Cigna Commercial |
$125.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.63
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
DX ER FINGER RT 3RD DIGIT
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F7
|
| Hospital Charge Code |
94270183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
|
|
DX ER FINGER RT 3RD DIGIT
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F7
|
| Hospital Charge Code |
94270183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$75.30
|
| Rate for Payer: Aetna Medicare Advantage |
$75.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.00
|
| Rate for Payer: Cigna Commercial |
$125.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.63
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
DX ER FINGER RT 4TH DIGIT
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F8
|
| Hospital Charge Code |
94270185
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
|
|
DX ER FINGER RT 4TH DIGIT
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F8
|
| Hospital Charge Code |
94270185
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$75.30
|
| Rate for Payer: Aetna Medicare Advantage |
$75.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.00
|
| Rate for Payer: Cigna Commercial |
$125.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.63
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
DX ER FINGER RT 5TH DIGIT
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F9
|
| Hospital Charge Code |
94270187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$75.30
|
| Rate for Payer: Aetna Medicare Advantage |
$75.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.00
|
| Rate for Payer: Cigna Commercial |
$125.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.63
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
DX ER FINGER RT 5TH DIGIT
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F9
|
| Hospital Charge Code |
94270187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
|
|
DX ER FINGER RT THUMB
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F5
|
| Hospital Charge Code |
94270179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$75.30
|
| Rate for Payer: Aetna Medicare Advantage |
$75.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.00
|
| Rate for Payer: Cigna Commercial |
$125.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.63
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
DX ER FINGER RT THUMB
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 73140F5
|
| Hospital Charge Code |
94270179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
|
|
DX ER FINGERS BILAT
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
94270055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
DX ER FINGERS BILAT
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
94270055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$75.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$207.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.50
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
DX ER FOOT 3 VIEWS LT
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
HCPCS 73630LT
|
| Hospital Charge Code |
94270231
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$93.30
|
| Rate for Payer: Aetna Medicare Advantage |
$93.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.31
|
| Rate for Payer: Cigna Commercial |
$155.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.43
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
DX ER FOOT 3 VIEWS LT
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
HCPCS 73630LT
|
| Hospital Charge Code |
94270231
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$46.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.65
|
|
|
DX ER FOOT 3 VIEWS RT
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
HCPCS 73630RT
|
| Hospital Charge Code |
94270233
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$93.30
|
| Rate for Payer: Aetna Medicare Advantage |
$93.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.31
|
| Rate for Payer: Cigna Commercial |
$155.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.43
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
DX ER FOOT 3 VIEWS RT
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
HCPCS 73630RT
|
| Hospital Charge Code |
94270233
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$46.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.65
|
|
|
DX ER FOOT AP & LAT BILAT
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 7362050
|
| Hospital Charge Code |
94270107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$75.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.50
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
DX ER FOOT AP & LAT BILAT
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 7362050
|
| Hospital Charge Code |
94270107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
DX ER FOOT AP & LAT LT
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
HCPCS 73620LT
|
| Hospital Charge Code |
94270227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$47.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.10
|
|
|
DX ER FOOT AP & LAT LT
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS 73620LT
|
| Hospital Charge Code |
94270227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.82 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$94.20
|
| Rate for Payer: Aetna Medicare Advantage |
$94.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$80.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$80.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$80.07
|
| Rate for Payer: Cigna Commercial |
$157.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.82
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|