|
ER-DII URE STRIC MALE INI
|
Facility
|
OP
|
$5,837.00
|
|
|
Service Code
|
HCPCS 53620
|
| Hospital Charge Code |
5790175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$3,005.06 |
| Rate for Payer: Aetna Commercial |
$2,253.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,684.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,005.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,005.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$828.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,005.06
|
| Rate for Payer: Cigna Commercial |
$1,660.53
|
| Rate for Payer: Cigna Medicare Advantage |
$828.41
|
| Rate for Payer: Clover Medicare Advantage |
$786.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,485.23
|
| Rate for Payer: Humana Medicare Advantage |
$853.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$828.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,517.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$875.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$828.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$165.77
|
|
|
ER DRAINAGE SKIN ABCESS
|
Facility
|
OP
|
$980.82
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
5700345
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$962.01 |
| 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 |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$864.65
|
| 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 |
$28.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$864.65
|
| 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 |
$255.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$962.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.86
|
|
|
ER DRAINAGE SKIN ABCESS
|
Facility
|
IP
|
$980.82
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
5700345
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$147.12 |
| Max. Negotiated Rate |
$147.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.12
|
|
|
ER DRAIN SCROTAL WALL ABSCESS
|
Facility
|
IP
|
$8,041.95
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
5700799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,206.29 |
| Max. Negotiated Rate |
$1,206.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,206.29
|
|
|
ER DRAIN SCROTAL WALL ABSCESS
|
Facility
|
OP
|
$8,041.95
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
5700799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$7,117.66 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,117.66
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,090.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,206.29
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$228.39
|
|
|
ER EKG
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
5780290
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$307.50 |
| Max. Negotiated Rate |
$307.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$307.50
|
|
|
ER EKG
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
5780290
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$58.22 |
| Max. Negotiated Rate |
$879.00 |
| Rate for Payer: Aetna Commercial |
$190.62
|
| Rate for Payer: Aetna Medicare Advantage |
$227.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$254.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$254.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$70.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$254.22
|
| Rate for Payer: Cigna Commercial |
$140.48
|
| Rate for Payer: Cigna Medicare Advantage |
$70.08
|
| Rate for Payer: Clover Medicare Advantage |
$66.58
|
| Rate for Payer: EmblemHealth Commercial |
$210.24
|
| Rate for Payer: Humana Medicare Advantage |
$72.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$70.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$533.00
|
| Rate for Payer: Oxford Commercial |
$659.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$307.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$879.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$64.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$58.22
|
|
|
ER ESCHAROTOMY INITIAL
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
5700721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$1,751.90 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,751.90
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.38
|
|
|
ER ESCHAROTOMY INITIAL
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
5700721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.80
|
|
|
ER EVACUATION SUBNGUAL HEMATOM
|
Facility
|
IP
|
$273.34
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
5700512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.00
|
|
|
ER EVACUATION SUBNGUAL HEMATOM
|
Facility
|
OP
|
$273.34
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
5700512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$573.36 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.36
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$197.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.76
|
|
|
ER EXCISION NAIL PARTIAL COMP
|
Facility
|
IP
|
$2,081.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
5700513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$312.15 |
| Max. Negotiated Rate |
$312.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$312.15
|
|
|
ER EXCISION NAIL PARTIAL COMP
|
Facility
|
OP
|
$2,081.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
5700513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$1,751.90 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$134.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,751.90
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$541.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$312.15
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$59.10
|
|
|
ER EXCISION OF INGROWN TOENAIL
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
5700514
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.80
|
|
|
ER EXCISION OF INGROWN TOENAIL
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
5700514
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$1,751.90 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,751.90
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.56
|
|
|
ER EXTENDED - IV
|
Facility
|
OP
|
$14,610.29
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
5700091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$3,833.00 |
| Rate for Payer: Aetna Commercial |
$1,348.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,606.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,798.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,798.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$495.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$620.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,798.22
|
| Rate for Payer: Cigna Commercial |
$993.68
|
| Rate for Payer: Cigna Medicare Advantage |
$495.72
|
| Rate for Payer: Clover Medicare Advantage |
$470.93
|
| Rate for Payer: EmblemHealth Commercial |
$1,487.16
|
| Rate for Payer: Humana Medicare Advantage |
$510.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$495.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,397.00
|
| Rate for Payer: Oxford Commercial |
$3,377.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,191.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,833.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$495.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$495.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$450.00
|
|
|
ER EXTENDED - IV
|
Facility
|
IP
|
$14,610.29
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
5700091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,191.54 |
| Max. Negotiated Rate |
$2,191.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,191.54
|
|
|
ER EXTENDED - IV W/O MF
|
Facility
|
OP
|
$6,586.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
5700090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$3,833.00 |
| Rate for Payer: Aetna Commercial |
$1,348.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,606.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,798.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,798.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$495.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$620.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,798.22
|
| Rate for Payer: Cigna Commercial |
$993.68
|
| Rate for Payer: Cigna Medicare Advantage |
$495.72
|
| Rate for Payer: Clover Medicare Advantage |
$470.93
|
| Rate for Payer: EmblemHealth Commercial |
$1,487.16
|
| Rate for Payer: Humana Medicare Advantage |
$510.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$495.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,397.00
|
| Rate for Payer: Oxford Commercial |
$3,377.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$987.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,833.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$495.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$495.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$450.00
|
|
|
ER EXTENDED - IV W/O MF
|
Facility
|
IP
|
$6,586.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
5700090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$987.90 |
| Max. Negotiated Rate |
$987.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$987.90
|
|
|
ER FB MUSC/TENDON SHEATH DEEP
|
Facility
|
IP
|
$9,772.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
5700722
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,465.80 |
| Max. Negotiated Rate |
$1,465.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,465.80
|
|
|
ER FB MUSC/TENDON SHEATH DEEP
|
Facility
|
OP
|
$9,772.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
5700722
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$12,518.07 |
| Rate for Payer: Aetna Commercial |
$9,386.39
|
| Rate for Payer: Aetna Medicare Advantage |
$11,180.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,518.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,518.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,450.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12,518.07
|
| Rate for Payer: Cigna Commercial |
$6,917.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3,450.88
|
| Rate for Payer: Clover Medicare Advantage |
$3,278.34
|
| Rate for Payer: EmblemHealth Commercial |
$10,352.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,554.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,450.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,540.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,465.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,450.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$277.52
|
|
|
ER FB MUSC/TENDON SHEATH SIMPL
|
Facility
|
OP
|
$7,903.25
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
5700546
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.56 |
| Max. Negotiated Rate |
$7,117.66 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$92.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,117.66
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,054.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,185.49
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$224.45
|
|
|
ER FB MUSC/TENDON SHEATH SIMPL
|
Facility
|
IP
|
$7,903.25
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
5700546
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,185.49 |
| Max. Negotiated Rate |
$1,185.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,185.49
|
|
|
ER-FB REM-CORN WOSLIT-BIL
|
Facility
|
IP
|
$1,128.75
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
5790855
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.31 |
| Max. Negotiated Rate |
$169.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$169.31
|
|
|
ER-FB REM-CORN WOSLIT-BIL
|
Facility
|
OP
|
$1,128.75
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
5790855
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$1,925.19 |
| Rate for Payer: Aetna Commercial |
$1,443.56
|
| Rate for Payer: Aetna Medicare Advantage |
$1,719.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,925.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,925.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$530.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,925.19
|
| Rate for Payer: Cigna Commercial |
$1,063.82
|
| Rate for Payer: Cigna Medicare Advantage |
$530.72
|
| Rate for Payer: Clover Medicare Advantage |
$504.18
|
| Rate for Payer: EmblemHealth Commercial |
$1,592.16
|
| Rate for Payer: Humana Medicare Advantage |
$546.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$530.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$293.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$169.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.06
|
|
