|
NJX INTERLAMINAR LMBR/SAC
|
Facility
|
OP
|
$5,965.40
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
16000356
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$188.51 |
| Max. Negotiated Rate |
$42,635.69 |
| Rate for Payer: Aetna Commercial |
$2,281.02
|
| Rate for Payer: Aetna Medicare Advantage |
$2,717.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,042.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,042.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$838.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,042.06
|
| Rate for Payer: Cigna Commercial |
$1,680.99
|
| Rate for Payer: Cigna Medicare Advantage |
$838.61
|
| Rate for Payer: Clover Medicare Advantage |
$796.68
|
| Rate for Payer: EmblemHealth Commercial |
$2,515.83
|
| Rate for Payer: Humana Medicare Advantage |
$863.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$838.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,551.00
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$894.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$188.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$42,635.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41,799.70
|
|
|
NJX INTERLAMINAR LMBR/SAC
|
Facility
|
IP
|
$5,965.40
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
16000433
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$894.81 |
| Max. Negotiated Rate |
$894.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$894.81
|
|
|
NJX INTERLAMINAR LMBR/SAC
|
Facility
|
OP
|
$5,965.40
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
16000433
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$188.51 |
| Max. Negotiated Rate |
$3,811.70 |
| Rate for Payer: Aetna Commercial |
$2,858.12
|
| Rate for Payer: Aetna Medicare Advantage |
$3,404.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,811.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,811.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,050.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,811.70
|
| Rate for Payer: Cigna Commercial |
$2,106.27
|
| Rate for Payer: Cigna Medicare Advantage |
$1,050.78
|
| Rate for Payer: Clover Medicare Advantage |
$998.24
|
| Rate for Payer: EmblemHealth Commercial |
$3,152.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,082.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,050.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,551.00
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$894.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$188.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,050.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,050.78
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,835.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,799.10
|
|
|
NJX NONCMPND SCLRSNT 1 VEIN
|
Facility
|
IP
|
$10,544.70
|
|
|
Service Code
|
HCPCS 36465
|
| Hospital Charge Code |
421036465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,581.70 |
| Max. Negotiated Rate |
$1,581.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,581.70
|
|
|
NJX NONCMPND SCLRSNT 1 VEIN
|
Facility
|
OP
|
$10,544.70
|
|
|
Service Code
|
HCPCS 36465
|
| Hospital Charge Code |
421036465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.47 |
| 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 |
$920.61
|
| 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 |
$2,741.62
|
| Rate for Payer: Oxford Commercial |
$2,108.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,581.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,108.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$333.21
|
| 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 |
$299.47
|
|
|
NJX NONCMPND SCLRSNT MLT VN
|
Facility
|
OP
|
$6,273.72
|
|
|
Service Code
|
HCPCS 36446
|
| Hospital Charge Code |
1600000792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.17 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$2,384.01
|
| Rate for Payer: Aetna Medicare Advantage |
$1,882.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,599.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,599.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,599.80
|
| Rate for Payer: Cigna Commercial |
$3,136.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$941.06
|
| Rate for Payer: UnitedHealthcare Community & State |
$198.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$178.17
|
|
|
NJX NONCMPND SCLRSNT MLT VN
|
Facility
|
IP
|
$6,273.72
|
|
|
Service Code
|
HCPCS 36446
|
| Hospital Charge Code |
1600000792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$941.06 |
| Max. Negotiated Rate |
$941.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$941.06
|
|
|
NJX NONCMPND SCLRSNT MLT VN
|
Facility
|
IP
|
$10,544.70
|
|
|
Service Code
|
HCPCS 36466
|
| Hospital Charge Code |
421036466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,581.70 |
| Max. Negotiated Rate |
$1,581.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,581.70
|
|
|
NJX NONCMPND SCLRSNT MLT VN
|
Facility
|
OP
|
$10,544.70
|
|
|
Service Code
|
HCPCS 36466
|
| Hospital Charge Code |
421036466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.47 |
| 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 |
$961.83
|
| 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 |
$2,741.62
|
| Rate for Payer: Oxford Commercial |
$2,108.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,581.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,108.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$333.21
|
| 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 |
$299.47
|
|
|
NJX NONCMPND SCLRSNT MLT VN
|
Facility
|
IP
|
$10,544.70
|
|
|
Service Code
|
HCPCS 36466
|
| Hospital Charge Code |
1600000828
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,581.70 |
| Max. Negotiated Rate |
$1,581.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,581.70
|
|
|
NJX NONCMPND SCLRSNT MLT VN
|
Facility
|
OP
|
$10,544.70
|
|
|
Service Code
|
HCPCS 36466
|
| Hospital Charge Code |
1600000828
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$299.47 |
| 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 |
$3,536.00
|
| 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 |
$2,741.62
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,581.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$333.21
|
| 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 |
$299.47
|
|
|
NJX PLATELET PLASMA
|
Facility
|
IP
|
$9,053.98
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
1600000280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,358.10 |
| Max. Negotiated Rate |
$1,358.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,358.10
|
|
|
NJX PLATELET PLASMA
|
Facility
|
OP
|
$9,053.98
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
1600000280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$286.11 |
| Max. Negotiated Rate |
$3,536.00 |
| 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 |
$3,536.00
|
| 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 |
$2,354.03
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,358.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$286.11
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$935.08
|
|
|
NJX SCLRSNT SPIDER VEINS
|
Facility
|
IP
|
$2,127.90
|
|
|
Service Code
|
HCPCS 36468
|
| Hospital Charge Code |
421036468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.19 |
| Max. Negotiated Rate |
$319.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.19
|
|
|
NJX SCLRSNT SPIDER VEINS
|
Facility
|
OP
|
$2,127.90
|
|
|
Service Code
|
HCPCS 36468
|
| Hospital Charge Code |
421036468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.18 |
| 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 |
$16.18
|
| 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 |
$553.25
|
| Rate for Payer: Oxford Commercial |
$425.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$425.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.43
|
|
|
NL SCREW 2.7 X12
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: Aetna Commercial |
$184.30
|
| Rate for Payer: Aetna Medicare Advantage |
$145.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$123.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$123.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$123.67
|
| Rate for Payer: Cigna Commercial |
$242.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.77
|
|
|
NL SCREW 2.7 X12
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.75
|
|
|
NL SCREW 2.7 X14
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.75
|
|
|
NL SCREW 2.7 X14
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: Aetna Commercial |
$184.30
|
| Rate for Payer: Aetna Medicare Advantage |
$145.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$123.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$123.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$123.67
|
| Rate for Payer: Cigna Commercial |
$242.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.77
|
|
|
NL SCREW 2.7 X 16
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.75
|
|
|
NL SCREW 2.7 X 16
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: Aetna Commercial |
$184.30
|
| Rate for Payer: Aetna Medicare Advantage |
$145.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$123.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$123.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$123.67
|
| Rate for Payer: Cigna Commercial |
$242.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.77
|
|
|
NM ABSCESS LOCALIZ WB
|
Facility
|
OP
|
$12,000.00
|
|
|
Service Code
|
HCPCS 78806
|
| Hospital Charge Code |
4500617
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$340.80 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Aetna Commercial |
$4,560.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,060.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,060.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,060.00
|
| Rate for Payer: Cigna Commercial |
$6,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,120.00
|
| Rate for Payer: Oxford Commercial |
$4,820.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,800.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,748.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$379.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$340.80
|
|
|
NM ABSCESS LOCALIZ WB
|
Facility
|
IP
|
$12,000.00
|
|
|
Service Code
|
HCPCS 78806
|
| Hospital Charge Code |
4500617
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,800.00
|
|
|
NM BONE IMAGING LIMITED
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
4500941
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$217.95 |
| Max. Negotiated Rate |
$217.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.95
|
|
|
NM BONE IMAGING LIMITED
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
4500941
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$4,820.00 |
| Rate for Payer: Aetna Commercial |
$1,291.84
|
| Rate for Payer: Aetna Medicare Advantage |
$1,538.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,722.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,722.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$474.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,722.84
|
| Rate for Payer: Cigna Commercial |
$952.02
|
| Rate for Payer: Cigna Medicare Advantage |
$332.46
|
| Rate for Payer: Clover Medicare Advantage |
$451.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,424.82
|
| Rate for Payer: Humana Medicare Advantage |
$489.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$474.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$377.78
|
| Rate for Payer: Oxford Commercial |
$4,820.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,748.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$474.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$474.94
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$185.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.27
|
|