|
ER MD VENIPUNCTR FEM/JUG <3YRS
|
Facility
|
IP
|
$301.25
|
|
|
Service Code
|
HCPCS 36400
|
| Hospital Charge Code |
5700777
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$45.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.19
|
|
|
ER-METACARPAL FRACTUR-BIL
|
Facility
|
IP
|
$612.00
|
|
| Hospital Charge Code |
5790480
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
|
|
ER-METACARPAL FRACTUR-BIL
|
Facility
|
OP
|
$612.00
|
|
| Hospital Charge Code |
5790480
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Medicare Advantage |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$156.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$156.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$156.06
|
| Rate for Payer: Cigna Commercial |
$306.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$79.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
|
|
ER-METATARSAL FRACTUR-BIL
|
Facility
|
IP
|
$612.00
|
|
| Hospital Charge Code |
5790635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
|
|
ER-METATARSAL FRACTUR-BIL
|
Facility
|
OP
|
$612.00
|
|
| Hospital Charge Code |
5790635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Medicare Advantage |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$156.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$156.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$156.06
|
| Rate for Payer: Cigna Commercial |
$306.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$79.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
|
|
ER-MP FINGER DISLOCAT-BIL
|
Facility
|
OP
|
$612.00
|
|
| Hospital Charge Code |
5790505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Medicare Advantage |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$156.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$156.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$156.06
|
| Rate for Payer: Cigna Commercial |
$306.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$79.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
|
|
ER-MP FINGER DISLOCAT-BIL
|
Facility
|
IP
|
$612.00
|
|
| Hospital Charge Code |
5790505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
|
|
ER-MP TOE DISLOCATED-BI
|
Facility
|
OP
|
$3,956.00
|
|
| Hospital Charge Code |
5790670
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$514.28 |
| Max. Negotiated Rate |
$1,978.00 |
| Rate for Payer: Aetna Commercial |
$1,186.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,186.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,008.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,008.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,008.78
|
| Rate for Payer: Cigna Commercial |
$1,978.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$514.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$593.40
|
|
|
ER-MP TOE DISLOCATED-BI
|
Facility
|
IP
|
$3,956.00
|
|
| Hospital Charge Code |
5790670
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$593.40 |
| Max. Negotiated Rate |
$593.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$593.40
|
|
|
ER-NAIL AVULSION-BILAT
|
Facility
|
IP
|
$362.00
|
|
| Hospital Charge Code |
5790265
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$54.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.30
|
|
|
ER-NAIL AVULSION-BILAT
|
Facility
|
OP
|
$362.00
|
|
| Hospital Charge Code |
5790265
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$181.00 |
| Rate for Payer: Aetna Commercial |
$108.60
|
| Rate for Payer: Aetna Medicare Advantage |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.31
|
| Rate for Payer: Cigna Commercial |
$181.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.30
|
|
|
ER NEEDLE ASPIRATION BLADDER
|
Facility
|
OP
|
$1,104.55
|
|
|
Service Code
|
HCPCS 51100
|
| Hospital Charge Code |
5700796
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.59 |
| Max. Negotiated Rate |
$594.98 |
| Rate for Payer: Aetna Commercial |
$331.37
|
| Rate for Payer: Aetna Medicare Advantage |
$331.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$281.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$281.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$281.66
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.68
|
|
|
ER NEEDLE ASPIRATION BLADDER
|
Facility
|
IP
|
$1,104.55
|
|
|
Service Code
|
HCPCS 51100
|
| Hospital Charge Code |
5700796
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.68 |
| Max. Negotiated Rate |
$165.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.68
|
|
|
ER NEWBORN RESUSCITATION
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS 99465
|
| Hospital Charge Code |
5700820
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.45 |
| Max. Negotiated Rate |
$201.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.45
|
|
|
ER NEWBORN RESUSCITATION
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS 99465
|
| Hospital Charge Code |
5700820
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.59 |
| Max. Negotiated Rate |
$1,573.96 |
| Rate for Payer: Aetna Commercial |
$402.90
|
| Rate for Payer: Aetna Medicare Advantage |
$402.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$342.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$342.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$342.46
|
| Rate for Payer: Cigna Commercial |
$1,573.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.45
|
|
|
ER-NG TUBE INSERTION
|
Facility
|
OP
|
$523.78
|
|
|
Service Code
|
HCPCS 4375259
|
| Hospital Charge Code |
5770045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.09 |
| Max. Negotiated Rate |
$261.89 |
| Rate for Payer: Aetna Commercial |
$157.13
|
| Rate for Payer: Aetna Medicare Advantage |
$157.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.56
|
| Rate for Payer: Cigna Commercial |
$261.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$68.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.57
|
|
|
ER-NG TUBE INSERTION
|
Facility
|
IP
|
$523.78
|
|
|
Service Code
|
HCPCS 4375259
|
| Hospital Charge Code |
5770045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.57 |
| Max. Negotiated Rate |
$78.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.57
|
|
|
ER OPEN DIS PHAL FINGER EACH
|
Facility
|
IP
|
$15,508.45
|
|
|
Service Code
|
HCPCS 26765
|
| Hospital Charge Code |
5700672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,326.27 |
| Max. Negotiated Rate |
$2,326.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,326.27
|
|
|
ER OPEN DIS PHAL FINGER EACH
|
Facility
|
OP
|
$15,508.45
|
|
|
Service Code
|
HCPCS 26765
|
| Hospital Charge Code |
5700672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$7,791.93 |
| Rate for Payer: Aetna Commercial |
$4,652.53
|
| Rate for Payer: Aetna Medicare Advantage |
$4,652.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,954.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,954.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,954.65
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,016.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,326.27
|
|
|
ER OPEN RED OF THUMB IP SUBLX
|
Facility
|
OP
|
$3,127.15
|
|
|
Service Code
|
HCPCS 26785
|
| Hospital Charge Code |
5700322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$147.31 |
| Max. Negotiated Rate |
$7,791.93 |
| Rate for Payer: Aetna Commercial |
$938.14
|
| Rate for Payer: Aetna Medicare Advantage |
$938.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$797.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$797.42
|
| 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 |
$797.42
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$469.07
|
|
|
ER OPEN RED OF THUMB IP SUBLX
|
Facility
|
IP
|
$3,127.15
|
|
|
Service Code
|
HCPCS 26785
|
| Hospital Charge Code |
5700322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$469.07 |
| Max. Negotiated Rate |
$469.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$469.07
|
|
|
ER OPEN TX FINGER EXT TENDON
|
Facility
|
OP
|
$5,243.75
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
5700576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$3,829.26 |
| Rate for Payer: Aetna Commercial |
$1,573.12
|
| Rate for Payer: Aetna Medicare Advantage |
$1,573.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,337.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,337.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$188.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,337.16
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$681.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$786.56
|
|
|
ER OPEN TX FINGER EXT TENDON
|
Facility
|
IP
|
$5,243.75
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
5700576
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$786.56 |
| Max. Negotiated Rate |
$786.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$786.56
|
|
|
ER OPERATIVE UPER GI ENDOSCOPY
|
Facility
|
OP
|
$3,673.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
5700830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.65 |
| Max. Negotiated Rate |
$2,159.89 |
| Rate for Payer: Aetna Commercial |
$1,101.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,101.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$936.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$936.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$936.62
|
| Rate for Payer: Cigna Commercial |
$2,159.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$550.95
|
|
|
ER OPERATIVE UPER GI ENDOSCOPY
|
Facility
|
IP
|
$3,673.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
5700830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$550.95 |
| Max. Negotiated Rate |
$550.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$550.95
|
|