|
ER INT REP NEK HAD FOT12.6-20
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
5700710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$3,185.09 |
| Rate for Payer: Aetna Commercial |
$2,388.27
|
| Rate for Payer: Aetna Medicare Advantage |
$2,844.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,185.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,185.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$878.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,185.09
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: Cigna Medicare Advantage |
$878.04
|
| Rate for Payer: Clover Medicare Advantage |
$834.14
|
| Rate for Payer: EmblemHealth Commercial |
$2,634.12
|
| Rate for Payer: Humana Medicare Advantage |
$904.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$878.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.60
|
|
|
ER INT REP NEK HAD FOT20.1-30
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
5700711
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$255.00
|
|
|
ER INT REP NEK HAD FOT20.1-30
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
5700711
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$3,185.09 |
| Rate for Payer: Aetna Commercial |
$2,388.27
|
| Rate for Payer: Aetna Medicare Advantage |
$2,844.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,185.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,185.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$878.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,185.09
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: Cigna Medicare Advantage |
$878.04
|
| Rate for Payer: Clover Medicare Advantage |
$834.14
|
| Rate for Payer: EmblemHealth Commercial |
$2,634.12
|
| Rate for Payer: Humana Medicare Advantage |
$904.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$878.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$442.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$255.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$48.28
|
|
|
ER INT REP NEK HAD FOT > 30 CM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
5700712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$8,891.84 |
| Rate for Payer: Aetna Commercial |
$6,667.35
|
| Rate for Payer: Aetna Medicare Advantage |
$7,941.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,891.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,891.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,451.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$214.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,891.84
|
| Rate for Payer: Cigna Commercial |
$4,913.48
|
| Rate for Payer: Cigna Medicare Advantage |
$2,451.23
|
| Rate for Payer: Clover Medicare Advantage |
$2,328.67
|
| Rate for Payer: EmblemHealth Commercial |
$7,353.69
|
| Rate for Payer: Humana Medicare Advantage |
$2,524.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,451.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$520.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.80
|
|
|
ER INT REP NEK HAD FOT > 30 CM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
5700712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ER INT REP NEK HAD FOT7.6-12.5
|
Facility
|
OP
|
$2,910.20
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
5700533
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$3,185.09 |
| Rate for Payer: Aetna Commercial |
$2,388.27
|
| Rate for Payer: Aetna Medicare Advantage |
$2,844.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,185.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,185.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$878.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$122.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,185.09
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: Cigna Medicare Advantage |
$878.04
|
| Rate for Payer: Clover Medicare Advantage |
$834.14
|
| Rate for Payer: EmblemHealth Commercial |
$2,634.12
|
| Rate for Payer: Humana Medicare Advantage |
$904.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$878.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$756.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$436.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,639.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$82.65
|
|
|
ER INT REP NEK HAD FOT7.6-12.5
|
Facility
|
IP
|
$2,910.20
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
5700533
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.53 |
| Max. Negotiated Rate |
$436.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$436.53
|
|
|
ER INT REP NEK HAND FOOT TO2.5
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
5700531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.67 |
| 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 |
$69.30
|
| 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 |
$280.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.00
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.67
|
|
|
ER INT REP NEK HAND FOOT TO2.5
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
5700531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.00
|
|
|
ER INT REP NEK TO TRUN 12.6-20
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
5700530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.50 |
| 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 |
$135.45
|
| 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 |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.50
|
|
|
ER INT REP NEK TO TRUN 12.6-20
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
5700530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
ER INT REP NEK TO TRUN 20.1-30
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
5700708
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
ER INT REP NEK TO TRUN 20.1-30
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
5700708
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$3,185.09 |
| Rate for Payer: Aetna Commercial |
$2,388.27
|
| Rate for Payer: Aetna Medicare Advantage |
$2,844.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,185.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,185.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$878.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$179.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,185.09
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: Cigna Medicare Advantage |
$878.04
|
| Rate for Payer: Clover Medicare Advantage |
$834.14
|
| Rate for Payer: EmblemHealth Commercial |
$2,634.12
|
| Rate for Payer: Humana Medicare Advantage |
$904.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$878.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,639.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.60
|
|
|
ER INT REP NEK TO TRUN 2.5-7.5
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
5700528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.95 |
| Max. Negotiated Rate |
$193.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$193.95
|
|
|
ER INT REP NEK TO TRUN 2.5-7.5
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
5700528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.72 |
| 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 |
$87.12
|
| 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 |
$336.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$193.95
|
| 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 |
$36.72
|
|
|
ER INT REP NEK TO TRUN >30 CM
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
5700709
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$9,062.33 |
| Rate for Payer: Aetna Commercial |
$6,667.35
|
| Rate for Payer: Aetna Medicare Advantage |
$7,941.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,891.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,891.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,451.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$211.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,891.84
|
| Rate for Payer: Cigna Commercial |
$4,913.48
|
| Rate for Payer: Cigna Medicare Advantage |
$2,451.23
|
| Rate for Payer: Clover Medicare Advantage |
$2,328.67
|
| Rate for Payer: EmblemHealth Commercial |
$7,353.69
|
| Rate for Payer: Humana Medicare Advantage |
$2,524.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,451.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$442.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$255.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,451.23
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$9,062.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$48.28
|
|
|
ER INT REP NEK TO TRUN >30 CM
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
5700709
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$255.00
|
|
|
ER INT REP NEK TO TRUN7.6-12.5
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
5700529
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.82 |
| 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 |
$109.66
|
| 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 |
$273.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.82
|
|
|
ER INT REP NEK TO TRUN7.6-12.5
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
5700529
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
ER INT REP NEK TO TRUN TO 2.5
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
5700527
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$15.48 |
| 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 |
$69.30
|
| 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 |
$141.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.75
|
| 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 |
$15.48
|
|
|
ER INT REP NEK TO TRUN TO 2.5
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
5700527
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.75 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.75
|
|
|
ER INTUBATION
|
Facility
|
IP
|
$1,278.15
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
5700288
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.72 |
| Max. Negotiated Rate |
$191.72 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$191.72
|
|
|
ER INTUBATION
|
Facility
|
OP
|
$1,278.15
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
5700288
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$1,020.71 |
| Rate for Payer: Aetna Commercial |
$765.35
|
| Rate for Payer: Aetna Medicare Advantage |
$911.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$281.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.71
|
| Rate for Payer: Cigna Commercial |
$564.04
|
| Rate for Payer: Cigna Medicare Advantage |
$281.38
|
| Rate for Payer: Clover Medicare Advantage |
$267.31
|
| Rate for Payer: EmblemHealth Commercial |
$844.14
|
| Rate for Payer: Humana Medicare Advantage |
$289.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$281.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$332.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$191.72
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$281.38
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$640.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.30
|
|
|
ER-IRRIGATION,BLADDER COMPLIC
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
5770030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.51 |
| Max. Negotiated Rate |
$554.54 |
| Rate for Payer: Aetna Commercial |
$415.81
|
| Rate for Payer: Aetna Medicare Advantage |
$495.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$554.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$554.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$152.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$91.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$554.54
|
| Rate for Payer: Cigna Commercial |
$306.43
|
| Rate for Payer: Cigna Medicare Advantage |
$152.87
|
| Rate for Payer: Clover Medicare Advantage |
$145.23
|
| Rate for Payer: EmblemHealth Commercial |
$458.61
|
| Rate for Payer: Humana Medicare Advantage |
$157.46
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$152.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$132.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$152.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$459.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.51
|
|
|
ER-IRRIGATION,BLADDER COMPLIC
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
5770030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$76.65 |
| Max. Negotiated Rate |
$76.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.65
|
|
