|
NUR CIRCUMCISION BY SLIT
|
Facility
|
IP
|
$1,727.00
|
|
|
Service Code
|
HCPCS 54160
|
| Hospital Charge Code |
93082070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$259.05 |
| Max. Negotiated Rate |
$259.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$259.05
|
|
|
NUR CIRCUMCISION BY SLIT
|
Facility
|
IP
|
$5,823.00
|
|
|
Service Code
|
HCPCS 54160
|
| Hospital Charge Code |
73092015
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$873.45 |
| Max. Negotiated Rate |
$873.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$873.45
|
|
|
NUR GALACTOSEMIA SCREEN
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 82776
|
| Hospital Charge Code |
93082080
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$31.93
|
| Rate for Payer: Aetna Medicare Advantage |
$38.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.59
|
| Rate for Payer: Cigna Commercial |
$17.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.74
|
| Rate for Payer: Clover Medicare Advantage |
$11.15
|
| Rate for Payer: EmblemHealth Commercial |
$35.22
|
| Rate for Payer: Humana Medicare Advantage |
$12.09
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.10
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.99
|
|
|
NUR GALACTOSEMIA SCREEN
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 82776
|
| Hospital Charge Code |
93082080
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.25
|
|
|
NUR HEMOGLOBIN SCREEN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
73092045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$14.99
|
| Rate for Payer: Aetna Medicare Advantage |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.99
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.51
|
| Rate for Payer: Clover Medicare Advantage |
$5.23
|
| Rate for Payer: EmblemHealth Commercial |
$16.53
|
| Rate for Payer: Humana Medicare Advantage |
$5.68
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.41
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
NUR HEMOGLOBIN SCREEN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
73092045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
NUR INSERTION CATH,ARTERY UMB
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS 36660
|
| Hospital Charge Code |
93082060
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$10,269.00 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.10
|
| 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 |
$107.10
|
| Rate for Payer: Cigna Commercial |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$109.20
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.93
|
|
|
NUR INSERTION CATH,ARTERY UMB
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 36660
|
| Hospital Charge Code |
73092005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
|
|
NUR INSERTION CATH,ARTERY UMB
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 36660
|
| Hospital Charge Code |
93082060
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
|
|
NUR INSERTION CATH,ARTERY UMB
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS 36660
|
| Hospital Charge Code |
73092005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$10,269.00 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.10
|
| 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 |
$107.10
|
| Rate for Payer: Cigna Commercial |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$109.20
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.93
|
|
|
NUR LUMBAR PUNC, NURSERY
|
Facility
|
OP
|
$3,185.75
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
93082075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.48 |
| Max. Negotiated Rate |
$3,629.00 |
| 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 |
$828.29
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$477.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$100.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$90.48
|
|
|
NUR LUMBAR PUNC, NURSERY
|
Facility
|
IP
|
$3,185.75
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
93082075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$477.86 |
| Max. Negotiated Rate |
$477.86 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$477.86
|
|
|
NUR LUMBAR PUNC, NURSERY
|
Facility
|
OP
|
$3,185.75
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
73092020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.48 |
| Max. Negotiated Rate |
$3,629.00 |
| 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 |
$828.29
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$477.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$100.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$90.48
|
|
|
NUR LUMBAR PUNC, NURSERY
|
Facility
|
IP
|
$3,185.75
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
73092020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$477.86 |
| Max. Negotiated Rate |
$477.86 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$477.86
|
|
|
NUR PKU
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 84030
|
| Hospital Charge Code |
93082085
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.25
|
|
|
NUR PKU
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84030
|
| Hospital Charge Code |
73092030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
NUR PKU
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 84030
|
| Hospital Charge Code |
93082085
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$14.96
|
| Rate for Payer: Aetna Medicare Advantage |
$17.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.95
|
| Rate for Payer: Cigna Commercial |
$17.50
|
| Rate for Payer: Cigna Medicare Advantage |
$5.50
|
| Rate for Payer: Clover Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$16.50
|
| Rate for Payer: Humana Medicare Advantage |
$5.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.10
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.99
|
|
|
NUR PKU
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84030
|
| Hospital Charge Code |
73092030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$14.96
|
| Rate for Payer: Aetna Medicare Advantage |
$17.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.95
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.50
|
| Rate for Payer: Clover Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$16.50
|
| Rate for Payer: Humana Medicare Advantage |
$5.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
NUR REMOVE DIGIT/SKIN TAG
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
93082055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
NUR REMOVE DIGIT/SKIN TAG
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
93082055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$3,536.00 |
| 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 |
$3,536.00
|
| 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 |
$130.00
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.20
|
|
|
NUT
|
Facility
|
IP
|
$19.10
|
|
| Hospital Charge Code |
270678083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.87
|
|
|
NUT
|
Facility
|
OP
|
$19.10
|
|
| Hospital Charge Code |
270678083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$7.26
|
| Rate for Payer: Aetna Medicare Advantage |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.87
|
| Rate for Payer: Cigna Commercial |
$9.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.97
|
| Rate for Payer: Oxford Commercial |
$3.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.54
|
|
|
NUT 10 MM
|
Facility
|
IP
|
$835.00
|
|
| Hospital Charge Code |
270684460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$125.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
|
|
NUT 10 MM
|
Facility
|
OP
|
$835.00
|
|
| Hospital Charge Code |
270684460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$417.50 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Medicare Advantage |
$250.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.93
|
| Rate for Payer: Cigna Commercial |
$417.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.10
|
| Rate for Payer: Oxford Commercial |
$167.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.71
|
|
|
NUT BUTTRESS COMPRESSION
|
Facility
|
OP
|
$3,229.65
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270697682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$1,614.83 |
| Rate for Payer: Aetna Commercial |
$1,227.27
|
| Rate for Payer: Aetna Medicare Advantage |
$968.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$823.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$823.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$823.56
|
| Rate for Payer: Cigna Commercial |
$1,614.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$839.71
|
| Rate for Payer: Oxford Commercial |
$645.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$484.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$645.93
|
| Rate for Payer: UnitedHealthcare Community & State |
$102.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$91.72
|
|