|
ER CLOSED TX POST ANTH DISWOAN
|
Facility
|
OP
|
$2,006.25
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
5700485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.85 |
| Max. Negotiated Rate |
$601.88 |
| Rate for Payer: Aetna Commercial |
$601.88
|
| Rate for Payer: Aetna Medicare Advantage |
$601.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$511.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$511.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$511.59
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.94
|
|
|
ER-CLOSED TX RADIUS FX-BI
|
Facility
|
OP
|
$1,791.00
|
|
| Hospital Charge Code |
5790420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$232.83 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Aetna Commercial |
$537.30
|
| Rate for Payer: Aetna Medicare Advantage |
$537.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$456.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$456.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$456.70
|
| Rate for Payer: Cigna Commercial |
$895.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$268.65
|
|
|
ER-CLOSED TX RADIUS FX-BI
|
Facility
|
IP
|
$1,791.00
|
|
| Hospital Charge Code |
5790420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$268.65 |
| Max. Negotiated Rate |
$268.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$268.65
|
|
|
ER CLOSED VERTEBRAL PROCESS FX
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 22305
|
| Hospital Charge Code |
5700553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CLOSED VERTEBRAL PROCESS FX
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS 22305
|
| Hospital Charge Code |
5700553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.29 |
| Max. Negotiated Rate |
$281.88 |
| Rate for Payer: Aetna Commercial |
$169.12
|
| Rate for Payer: Aetna Medicare Advantage |
$169.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$143.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$143.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$143.76
|
| Rate for Payer: Cigna Commercial |
$281.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER-CLOS TX COND HUM FX-BI
|
Facility
|
OP
|
$466.00
|
|
| Hospital Charge Code |
5790390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna Commercial |
$139.80
|
| Rate for Payer: Aetna Medicare Advantage |
$139.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$118.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$118.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$118.83
|
| Rate for Payer: Cigna Commercial |
$233.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.90
|
|
|
ER-CLOS TX COND HUM FX-BI
|
Facility
|
IP
|
$466.00
|
|
| Hospital Charge Code |
5790390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.90 |
| Max. Negotiated Rate |
$69.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.90
|
|
|
ER-CLOS TX LAT MALL FX-BI
|
Facility
|
OP
|
$466.00
|
|
| Hospital Charge Code |
5790595
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna Commercial |
$139.80
|
| Rate for Payer: Aetna Medicare Advantage |
$139.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$118.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$118.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$118.83
|
| Rate for Payer: Cigna Commercial |
$233.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.90
|
|
|
ER-CLOS TX LAT MALL FX-BI
|
Facility
|
IP
|
$466.00
|
|
| Hospital Charge Code |
5790595
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.90 |
| Max. Negotiated Rate |
$69.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.90
|
|
|
ER-CLO TX FEM SHAFT FX-BI
|
Facility
|
IP
|
$6,028.00
|
|
| Hospital Charge Code |
5790560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$904.20 |
| Max. Negotiated Rate |
$904.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$904.20
|
|
|
ER-CLO TX FEM SHAFT FX-BI
|
Facility
|
OP
|
$6,028.00
|
|
| Hospital Charge Code |
5790560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$783.64 |
| Max. Negotiated Rate |
$3,014.00 |
| Rate for Payer: Aetna Commercial |
$1,808.40
|
| Rate for Payer: Aetna Medicare Advantage |
$1,808.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,537.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,537.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,537.14
|
| Rate for Payer: Cigna Commercial |
$3,014.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$783.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$904.20
|
|
|
ER CLSD DIST FING FX W/MAN EAC
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
5700583
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.79 |
| Max. Negotiated Rate |
$587.42 |
| Rate for Payer: Aetna Commercial |
$169.12
|
| Rate for Payer: Aetna Medicare Advantage |
$169.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$143.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$143.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$64.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$143.76
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CLSD DIST FING FX W/MAN EAC
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
5700583
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CLSD DIST RADIOULNA DIS W/M
|
Facility
|
IP
|
$1,363.55
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
5700821
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.53 |
| Max. Negotiated Rate |
$204.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.53
|
|
|
ER CLSD DIST RADIOULNA DIS W/M
|
Facility
|
OP
|
$1,363.55
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
5700821
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$147.31 |
| Max. Negotiated Rate |
$587.42 |
| Rate for Payer: Aetna Commercial |
$409.06
|
| Rate for Payer: Aetna Medicare Advantage |
$409.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$347.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$347.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$347.71
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.53
|
|
|
ER CLSD FEMOR NCK FX W/O MAN
|
Facility
|
IP
|
$906.60
|
|
|
Service Code
|
HCPCS 27230
|
| Hospital Charge Code |
5700755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.99 |
| Max. Negotiated Rate |
$135.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.99
|
|
|
ER CLSD FEMOR NCK FX W/O MAN
|
Facility
|
OP
|
$906.60
|
|
|
Service Code
|
HCPCS 27230
|
| Hospital Charge Code |
5700755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.86 |
| Max. Negotiated Rate |
$587.42 |
| Rate for Payer: Aetna Commercial |
$271.98
|
| Rate for Payer: Aetna Medicare Advantage |
$271.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$230.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.18
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.99
|
|
|
ER CLSD GREAT TROCHNTER W/O MA
|
Facility
|
OP
|
$2,622.50
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
5700757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.95 |
| Max. Negotiated Rate |
$786.75 |
| Rate for Payer: Aetna Commercial |
$786.75
|
| Rate for Payer: Aetna Medicare Advantage |
$786.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$668.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$668.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$668.74
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$340.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.38
|
|
|
ER CLSD GREAT TROCHNTER W/O MA
|
Facility
|
IP
|
$2,622.50
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
5700757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.38 |
| Max. Negotiated Rate |
$393.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.38
|
|
|
ER CLSD HUME SFT FX W/ MANIP
|
Facility
|
IP
|
$7,914.45
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
5700740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,187.17 |
| Max. Negotiated Rate |
$1,187.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.17
|
|
|
ER CLSD HUME SFT FX W/ MANIP
|
Facility
|
OP
|
$7,914.45
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
5700740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.56 |
| Max. Negotiated Rate |
$3,829.26 |
| Rate for Payer: Aetna Commercial |
$2,374.34
|
| Rate for Payer: Aetna Medicare Advantage |
$2,374.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,018.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,018.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,018.18
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,028.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.17
|
|
|
ER CLSD HUME SFT FX W/O ANES
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
5700559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.29 |
| Max. Negotiated Rate |
$587.42 |
| Rate for Payer: Aetna Commercial |
$169.12
|
| Rate for Payer: Aetna Medicare Advantage |
$169.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$143.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$143.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$151.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$143.76
|
| Rate for Payer: Cigna Commercial |
$587.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CLSD HUME SFT FX W/O ANES
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
5700559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$84.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.56
|
|
|
ER CLSD PELVIC RING FX W/O MAN
|
Facility
|
IP
|
$906.60
|
|
|
Service Code
|
HCPCS 27193
|
| Hospital Charge Code |
5700754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.99 |
| Max. Negotiated Rate |
$135.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.99
|
|
|
ER CLSD PELVIC RING FX W/O MAN
|
Facility
|
OP
|
$906.60
|
|
|
Service Code
|
HCPCS 27193
|
| Hospital Charge Code |
5700754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.86 |
| Max. Negotiated Rate |
$453.30 |
| Rate for Payer: Aetna Commercial |
$271.98
|
| Rate for Payer: Aetna Medicare Advantage |
$271.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.18
|
| Rate for Payer: Cigna Commercial |
$453.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.99
|
|