|
ER RED RECTAL PROLAPSE
|
Facility
|
OP
|
$2,904.15
|
|
|
Service Code
|
HCPCS 45900
|
| Hospital Charge Code |
5792281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$4,007.70 |
| Rate for Payer: Aetna Commercial |
$3,005.08
|
| Rate for Payer: Aetna Medicare Advantage |
$3,579.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,007.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,007.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,104.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,007.70
|
| Rate for Payer: Cigna Commercial |
$2,214.60
|
| Rate for Payer: Cigna Medicare Advantage |
$1,104.81
|
| Rate for Payer: Clover Medicare Advantage |
$1,049.57
|
| Rate for Payer: EmblemHealth Commercial |
$3,314.43
|
| Rate for Payer: Humana Medicare Advantage |
$1,137.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,104.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$755.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,104.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,104.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$82.48
|
|
|
ER RED RECTAL PROLAPSE
|
Facility
|
IP
|
$2,904.15
|
|
|
Service Code
|
HCPCS 45900
|
| Hospital Charge Code |
5792281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.62 |
| Max. Negotiated Rate |
$435.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.62
|
|
|
ER REDUCT TOE MP DISC W/O ANES
|
Facility
|
IP
|
$1,175.15
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
5700772
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.27 |
| Max. Negotiated Rate |
$176.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.27
|
|
|
ER REDUCT TOE MP DISC W/O ANES
|
Facility
|
OP
|
$1,175.15
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
5700772
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.37 |
| 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 |
$67.10
|
| 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 |
$305.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.27
|
| 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 |
$33.37
|
|
|
ER REGIONAL BLOCK
|
Facility
|
OP
|
$1,398.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
5700804
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.70 |
| Max. Negotiated Rate |
$1,322.84 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,322.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,322.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,322.84
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$209.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.70
|
|
|
ER REGIONAL BLOCK
|
Facility
|
IP
|
$1,398.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
5700804
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$209.70 |
| Max. Negotiated Rate |
$209.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$209.70
|
|
|
ER REM FB CONJUNCTIVA SUPERFAL
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
5700418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$59.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.55
|
|
|
ER REM FB CONJUNCTIVA SUPERFAL
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
5700418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.27 |
| 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 |
$24.64
|
| 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 |
$103.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.55
|
| 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: Wellpoint Medicaid Managed Care |
$11.27
|
|
|
ER REM FB OUTER EAR CAN W/O AN
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
5700500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.10 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.10
|
|
|
ER REM FB OUTER EAR CAN W/O AN
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
5700500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.78 |
| 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 |
$20.02
|
| 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 |
$71.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.10
|
| 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: Wellpoint Medicaid Managed Care |
$7.78
|
|
|
ER REM FOREIGN BODY, SUBQ FOOT
|
Facility
|
IP
|
$3,473.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
5700470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.95 |
| Max. Negotiated Rate |
$520.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$520.95
|
|
|
ER REM FOREIGN BODY, SUBQ FOOT
|
Facility
|
OP
|
$3,473.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
5700470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$3,051.74 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,051.74
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$902.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$520.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$98.63
|
|
|
ER REM OF EMBEDDED FB EYELID
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
5700673
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$1,367.89 |
| Rate for Payer: Aetna Commercial |
$1,025.68
|
| Rate for Payer: Aetna Medicare Advantage |
$1,221.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,367.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,367.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$377.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,367.89
|
| Rate for Payer: Cigna Commercial |
$755.86
|
| Rate for Payer: Cigna Medicare Advantage |
$377.09
|
| Rate for Payer: Clover Medicare Advantage |
$358.24
|
| Rate for Payer: EmblemHealth Commercial |
$1,131.27
|
| Rate for Payer: Humana Medicare Advantage |
$388.40
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$377.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$245.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$377.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$377.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.81
|
|
|
ER REM OF EMBEDDED FB EYELID
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
5700673
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$141.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.60
|
|
|
ER REMOVAL FB NASAL
|
Facility
|
OP
|
$452.22
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
5700439
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$12.84 |
| 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 |
$24.64
|
| 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 |
$117.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.83
|
| 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: Wellpoint Medicaid Managed Care |
$12.84
|
|
|
ER REMOVAL FB NASAL
|
Facility
|
IP
|
$452.22
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
5700439
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.83 |
| Max. Negotiated Rate |
$67.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.83
|
|
|
ER REMOVAL FB PHARYNX
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
5700649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.10 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.10
|
|
|
ER REMOVAL FB PHARYNX
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
5700649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.78 |
| 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 |
$79.94
|
| 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 |
$71.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.10
|
| 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 |
$7.78
|
|
|
ER REMOVAL INTRAURINE DEVICE
|
Facility
|
IP
|
$1,621.70
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
5701004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.25 |
| Max. Negotiated Rate |
$243.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.25
|
|
|
ER REMOVAL INTRAURINE DEVICE
|
Facility
|
OP
|
$1,621.70
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
5701004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$1,313.26 |
| Rate for Payer: Aetna Commercial |
$984.72
|
| Rate for Payer: Aetna Medicare Advantage |
$1,172.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,313.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,313.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$362.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,313.26
|
| Rate for Payer: Cigna Commercial |
$725.69
|
| Rate for Payer: Cigna Medicare Advantage |
$362.03
|
| Rate for Payer: Clover Medicare Advantage |
$343.93
|
| Rate for Payer: EmblemHealth Commercial |
$1,086.09
|
| Rate for Payer: Humana Medicare Advantage |
$372.89
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$362.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$421.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$362.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$362.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.06
|
|
|
ER REMOV COREAL FB W/ SLIT LMP
|
Facility
|
OP
|
$522.50
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
5700806
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.84 |
| 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 |
$52.80
|
| 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 |
$135.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.38
|
| 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: Wellpoint Medicaid Managed Care |
$14.84
|
|
|
ER REMOV COREAL FB W/ SLIT LMP
|
Facility
|
IP
|
$522.50
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
5700806
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$78.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.38
|
|
|
ER REM TUNN CV CATH W/O PO/PUM
|
Facility
|
OP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
5701002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$2,703.39 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,703.39
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$745.25
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$943.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$103.11
|
|
|
ER REM TUNN CV CATH W/O PO/PUM
|
Facility
|
IP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
5701002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$544.61 |
| Max. Negotiated Rate |
$544.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
|
|
ER-REPAIR BLD VESS UP EXT
|
Facility
|
OP
|
$10,555.00
|
|
|
Service Code
|
HCPCS 35206
|
| Hospital Charge Code |
5790090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$451.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$3,751.17
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,744.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,583.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$299.76
|
|
