|
ER CLSD TX CALCANEUS W/O MAN
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
5700768
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$1,063.04 |
| 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 |
$1,063.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,063.04
|
| 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 |
$114.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,063.04
|
| 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 |
$167.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.32
|
|
|
ER CLSD TX CLAVICLE W/ MANIP
|
Facility
|
OP
|
$8,519.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
5700731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$6,929.76 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,929.76
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,214.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,277.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$241.94
|
|
|
ER CLSD TX CLAVICLE W/ MANIP
|
Facility
|
IP
|
$8,519.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
5700731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,277.85 |
| Max. Negotiated Rate |
$1,277.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,277.85
|
|
|
ER CLSD TX DISLO SHLD W/O ANES
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
5700558
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.75 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
|
|
ER CLSD TX DISLO SHLD W/O ANES
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
5700558
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$1,063.04 |
| 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 |
$1,063.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,063.04
|
| 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 |
$60.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,063.04
|
| 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 |
$167.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.32
|
|
|
ER CLSD TX FEMORAL SFT W MAN
|
Facility
|
IP
|
$10,062.15
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
5700761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,509.32 |
| Max. Negotiated Rate |
$1,509.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,509.32
|
|
|
ER CLSD TX FEMORAL SFT W MAN
|
Facility
|
OP
|
$10,062.15
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
5700761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$6,929.76 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$372.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,929.76
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,616.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,509.32
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$285.77
|
|
|
ER CLSD TX FEMORAL SFT WO MAN
|
Facility
|
OP
|
$2,251.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
5700760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.93 |
| Max. Negotiated Rate |
$1,063.04 |
| 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 |
$1,063.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,063.04
|
| 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 |
$239.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,063.04
|
| 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 |
$585.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.93
|
|
|
ER CLSD TX FEMORAL SFT WO MAN
|
Facility
|
IP
|
$2,251.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
5700760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.65 |
| Max. Negotiated Rate |
$337.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.65
|
|
|
ER CLSD TX GREAT TOE W/ MAN
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
5700771
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.75 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
|
|
ER CLSD TX GREAT TOE W/ MAN
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
5700771
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$1,063.04 |
| 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 |
$1,063.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,063.04
|
| 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 |
$66.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,063.04
|
| 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 |
$167.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.32
|
|
|
ER CLSD TX GR TUB FX W/O MAN
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS 23620
|
| Hospital Charge Code |
5700557
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$1,063.04 |
| 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 |
$1,063.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,063.04
|
| 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 |
$119.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,063.04
|
| 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 |
$167.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.32
|
|
|
ER CLSD TX GR TUB FX W/O MAN
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
HCPCS 23620
|
| Hospital Charge Code |
5700557
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.75 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
|
|
ER CLSD TX HUM COND FX W MAN
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 24577
|
| Hospital Charge Code |
5700744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.25
|
|
|
ER CLSD TX HUM COND FX W MAN
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 24577
|
| Hospital Charge Code |
5700744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$6,929.76 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,929.76
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$185.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.31
|
|
|
ER CLSD TX HUM COND FX W/O MAN
|
Facility
|
OP
|
$1,978.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
5700743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$1,063.04 |
| 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 |
$1,063.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,063.04
|
| 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 |
$92.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,063.04
|
| 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 |
$514.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.18
|
|
|
ER CLSD TX HUM COND FX W/O MAN
|
Facility
|
IP
|
$1,978.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
5700743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.70 |
| Max. Negotiated Rate |
$296.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.70
|
|
|
ER CLSD TX HUM EPI FX W MANI
|
Facility
|
OP
|
$1,125.13
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
5700742
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$6,929.76 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$226.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,929.76
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.77
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.95
|
|
|
ER CLSD TX HUM EPI FX W MANI
|
Facility
|
IP
|
$1,125.13
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
5700742
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.77 |
| Max. Negotiated Rate |
$168.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.77
|
|
|
ER CLSD TX HUM EPI FX W/O ANES
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
5700561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.75 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
|
|
ER CLSD TX HUM EPI FX W/O ANES
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
5700561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$1,063.04 |
| 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 |
$1,063.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,063.04
|
| 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 |
$127.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,063.04
|
| 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 |
$167.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.32
|
|
|
ER CLSD TX LUNA DISLOC W/MANIP
|
Facility
|
IP
|
$8,605.25
|
|
|
Service Code
|
HCPCS 25690
|
| Hospital Charge Code |
323025690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,290.79 |
| Max. Negotiated Rate |
$1,290.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,290.79
|
|
|
ER CLSD TX LUNA DISLOC W/MANIP
|
Facility
|
OP
|
$8,605.25
|
|
|
Service Code
|
HCPCS 25690
|
| Hospital Charge Code |
323025690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$6,929.76 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$218.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,929.76
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,237.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,290.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$244.39
|
|
|
ER CLSD TX METACARPO W MANI
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
5700829
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.75 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
|
|
ER CLSD TX METACARPO W MANI
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
5700829
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$6,929.76 |
| Rate for Payer: Aetna Commercial |
$5,196.12
|
| Rate for Payer: Aetna Medicare Advantage |
$6,189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,929.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,910.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$131.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,929.76
|
| Rate for Payer: Cigna Commercial |
$3,829.26
|
| Rate for Payer: Cigna Medicare Advantage |
$1,910.34
|
| Rate for Payer: Clover Medicare Advantage |
$1,814.82
|
| Rate for Payer: EmblemHealth Commercial |
$5,731.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,967.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,910.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$167.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,910.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.32
|
|
