|
ER SIM REP NCK TO TRUN OVER 30
|
Facility
|
OP
|
$1,768.00
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
5700519
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.21 |
| Max. Negotiated Rate |
$864.65 |
| 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 |
$153.99
|
| 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 |
$459.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$265.20
|
| 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: Wellpoint Medicaid Managed Care |
$50.21
|
|
|
ER SIM REP NEK TO TRUN20.1-30
|
Facility
|
OP
|
$1,442.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
5700518
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.95 |
| 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 |
$136.09
|
| 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 |
$374.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.30
|
| 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 |
$40.95
|
|
|
ER SIM REP NEK TO TRUN20.1-30
|
Facility
|
IP
|
$1,442.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
5700518
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$216.30 |
| Max. Negotiated Rate |
$216.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.30
|
|
|
ER SIM REP NEK TO TRUNK12.6-20
|
Facility
|
IP
|
$787.87
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
5700517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.18 |
| Max. Negotiated Rate |
$118.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.18
|
|
|
ER SIM REP NEK TO TRUNK12.6-20
|
Facility
|
OP
|
$787.87
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
5700517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.38 |
| 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 |
$109.67
|
| 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 |
$204.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.18
|
| 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 |
$22.38
|
|
|
ER SIM WOUND DEHIS REP W/PACK
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
5700707
|
|
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 |
$71.81
|
| 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 SIM WOUND DEHIS REP W/PACK
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
5700707
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.95 |
| Max. Negotiated Rate |
$193.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$193.95
|
|
|
ER SKIN AUTOGRAFT
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
5790117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.35 |
| Max. Negotiated Rate |
$142.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.35
|
|
|
ER SKIN AUTOGRAFT
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
5790117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$15,271.92 |
| Rate for Payer: Aetna Commercial |
$11,451.31
|
| Rate for Payer: Aetna Medicare Advantage |
$13,640.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,271.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,271.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,210.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$535.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15,271.92
|
| Rate for Payer: Cigna Commercial |
$8,439.01
|
| Rate for Payer: Cigna Medicare Advantage |
$4,210.04
|
| Rate for Payer: Clover Medicare Advantage |
$3,999.54
|
| Rate for Payer: EmblemHealth Commercial |
$12,630.12
|
| Rate for Payer: Humana Medicare Advantage |
$4,336.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,210.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.35
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,210.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,210.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.95
|
|
|
ER-SKIN TISSUE REARRANGMT
|
Facility
|
OP
|
$9,070.55
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
5790020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.79 |
| 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 |
$319.94
|
| 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 |
$2,358.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,360.58
|
| 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 |
$65.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$257.60
|
|
|
ER-SKIN TISSUE REARRANGMT
|
Facility
|
IP
|
$9,070.55
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
5790020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,360.58 |
| Max. Negotiated Rate |
$1,360.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,360.58
|
|
|
ER SPLINT LONG LEG
|
Facility
|
IP
|
$777.42
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
5700450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.61 |
| Max. Negotiated Rate |
$116.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.61
|
|
|
ER SPLINT LONG LEG
|
Facility
|
OP
|
$777.42
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
5700450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$700.29 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Medicare Advantage |
$625.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$700.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$700.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$193.05
|
| 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 |
$700.29
|
| Rate for Payer: Cigna Commercial |
$386.97
|
| Rate for Payer: Cigna Medicare Advantage |
$193.05
|
| Rate for Payer: Clover Medicare Advantage |
$183.40
|
| Rate for Payer: EmblemHealth Commercial |
$579.15
|
| Rate for Payer: Humana Medicare Advantage |
$198.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$193.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.08
|
|
|
ER STAPPING ELBOW OR WRIST
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
5700613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$68.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.70
|
|
|
ER STAPPING ELBOW OR WRIST
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
5700613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$254.22 |
| 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 |
$24.87
|
| 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 |
$119.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.01
|
|
|
ER STRAPPING HAND/FINGER
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
5700614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$68.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.70
|
|
|
ER STRAPPING HAND/FINGER
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
5700614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$254.22 |
| 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 |
$30.95
|
| 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 |
$119.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.01
|
|
|
ER STRAPPING OF ANKLE RIGHT
|
Facility
|
IP
|
$348.75
|
|
|
Service Code
|
HCPCS 29540RT
|
| Hospital Charge Code |
5700335
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$52.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.31
|
|
|
ER STRAPPING OF ANKLE RIGHT
|
Facility
|
OP
|
$348.75
|
|
|
Service Code
|
HCPCS 29540RT
|
| Hospital Charge Code |
5700335
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$132.53
|
| Rate for Payer: Aetna Medicare Advantage |
$104.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$88.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$88.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$88.93
|
| Rate for Payer: Cigna Commercial |
$174.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.90
|
|
|
ER STRAPPING OF KNEE
|
Facility
|
OP
|
$988.72
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
5700300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.40 |
| 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 |
$26.40
|
| 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 |
$257.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$148.31
|
| 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 |
$28.08
|
|
|
ER STRAPPING OF KNEE
|
Facility
|
IP
|
$988.72
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
5700300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.31 |
| Max. Negotiated Rate |
$148.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$148.31
|
|
|
ER STRAPPING OF SHOULDER
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
5700350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$68.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.70
|
|
|
ER STRAPPING OF SHOULDER
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
5700350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.01 |
| 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 |
$29.99
|
| 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 |
$119.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.70
|
| 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 |
$13.01
|
|
|
ER STRAPPING TOES
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
5700616
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$254.22 |
| 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 |
$17.60
|
| 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 |
$119.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.01
|
|
|
ER STRAPPING TOES
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
5700616
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$68.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.70
|
|
