|
PNEUMONOCCOCAL VAC 0.5 ML VIAL
|
Facility
|
OP
|
$541.90
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
83652335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$270.95 |
| Rate for Payer: Aetna Commercial |
$205.92
|
| Rate for Payer: Aetna Medicare Advantage |
$162.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$138.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$138.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$138.18
|
| Rate for Payer: Cigna Commercial |
$270.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$131.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.28
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.39
|
|
|
PNEUMOTHORAX WITH CC
|
Facility
|
IP
|
$54,195.46
|
|
|
Service Code
|
MSDRG 200
|
| Min. Negotiated Rate |
$16,501.82 |
| Max. Negotiated Rate |
$54,195.46 |
| Rate for Payer: Aetna Commercial |
$40,457.14
|
| Rate for Payer: Aetna Medicare Advantage |
$54,195.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29,921.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29,921.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17,370.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29,921.40
|
| Rate for Payer: Cigna Commercial |
$24,506.69
|
| Rate for Payer: Cigna Medicare Advantage |
$17,370.34
|
| Rate for Payer: Clover Medicare Advantage |
$16,501.82
|
| Rate for Payer: EmblemHealth Commercial |
$52,111.02
|
| Rate for Payer: Humana Medicare Advantage |
$17,891.45
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17,370.34
|
| Rate for Payer: Oxford Commercial |
$19,369.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$25,926.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17,370.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$17,370.34
|
|
|
PNEUMOTHORAX WITH MCC
|
Facility
|
IP
|
$75,198.86
|
|
|
Service Code
|
MSDRG 199
|
| Min. Negotiated Rate |
$22,897.09 |
| Max. Negotiated Rate |
$75,198.86 |
| Rate for Payer: Aetna Commercial |
$55,416.01
|
| Rate for Payer: Aetna Medicare Advantage |
$75,198.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49,037.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49,037.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24,102.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49,037.85
|
| Rate for Payer: Cigna Commercial |
$39,327.08
|
| Rate for Payer: Cigna Medicare Advantage |
$24,102.20
|
| Rate for Payer: Clover Medicare Advantage |
$22,897.09
|
| Rate for Payer: EmblemHealth Commercial |
$72,306.60
|
| Rate for Payer: Humana Medicare Advantage |
$24,825.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24,102.20
|
| Rate for Payer: Oxford Commercial |
$31,083.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$41,606.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24,102.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$24,102.20
|
|
|
PNEUMOTHORAX WITHOUT CC/MCC
|
Facility
|
IP
|
$42,057.19
|
|
|
Service Code
|
MSDRG 201
|
| Min. Negotiated Rate |
$12,600.06 |
| Max. Negotiated Rate |
$42,057.19 |
| Rate for Payer: Aetna Commercial |
$31,812.13
|
| Rate for Payer: Aetna Medicare Advantage |
$42,057.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19,670.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19,670.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13,479.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19,670.55
|
| Rate for Payer: Cigna Commercial |
$15,941.72
|
| Rate for Payer: Cigna Medicare Advantage |
$13,479.87
|
| Rate for Payer: Clover Medicare Advantage |
$12,805.88
|
| Rate for Payer: EmblemHealth Commercial |
$40,439.61
|
| Rate for Payer: Humana Medicare Advantage |
$13,884.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13,479.87
|
| Rate for Payer: Oxford Commercial |
$12,600.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,865.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13,479.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$13,479.87
|
|
|
POC GLUCOSE
|
Facility
|
IP
|
$639.70
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
3100140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.95 |
| Max. Negotiated Rate |
$95.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.95
|
|
|
POC GLUCOSE
|
Facility
|
OP
|
$639.70
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
3100140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$319.85 |
| Rate for Payer: Aetna Commercial |
$13.71
|
| Rate for Payer: Aetna Medicare Advantage |
$16.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.28
|
| Rate for Payer: Cigna Commercial |
$319.85
|
| Rate for Payer: Cigna Medicare Advantage |
$5.04
|
| Rate for Payer: Clover Medicare Advantage |
$4.79
|
| Rate for Payer: EmblemHealth Commercial |
$15.12
|
| Rate for Payer: Humana Medicare Advantage |
$5.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$166.32
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.17
|
|
|
POCKET II UNITOME BLADE
|
Facility
|
OP
|
$308.00
|
|
| Hospital Charge Code |
270332560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Aetna Medicare Advantage |
$92.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.54
|
| Rate for Payer: Cigna Commercial |
$154.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.08
|
| Rate for Payer: Oxford Commercial |
$61.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$61.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.75
|
|
|
POCKET II UNITOME BLADE
|
Facility
|
IP
|
$308.00
|
|
| Hospital Charge Code |
270332560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$46.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.20
|
|
|
POCKET STRIP 10x2.5CM 20CC
|
Facility
|
IP
|
$26,000.00
|
|
| Hospital Charge Code |
270674946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,900.00 |
| Max. Negotiated Rate |
$6,292.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,292.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,900.00
|
|
|
POCKET STRIP 10x2.5CM 20CC
|
Facility
|
OP
|
$26,000.00
|
|
| Hospital Charge Code |
270674946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.40 |
| Max. Negotiated Rate |
$13,000.00 |
| Rate for Payer: Aetna Commercial |
$9,880.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,630.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,630.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,630.00
|
| Rate for Payer: Cigna Commercial |
$13,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,292.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,900.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$821.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$738.40
|
|
|
POD ASPIRATE BULA CYST, HEMA
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
84208010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.32 |
| Max. Negotiated Rate |
$7,117.66 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| 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 |
$7,117.66
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$158.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.28
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.32
|
|
|
POD ASPIRATE BULA CYST, HEMA
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
84208010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.50
|
|
|
POD AVULSION NAIL
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
84208065
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.56 |
| 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 |
$59.48
|
| 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 |
$96.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.56
|
|
|
POD AVULSION NAIL
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
84208065
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.80
|
|
|
POD BELOW KNEE CAST
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 29799
|
| Hospital Charge Code |
84208210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.01 |
| 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 |
$25.30
|
| 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 |
$119.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.47
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.01
|
|
|
POD BELOW KNEE CAST
|
Facility
|
IP
|
$1,360.45
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
84208175
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$204.07 |
| Max. Negotiated Rate |
$204.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.07
|
|
|
POD BELOW KNEE CAST
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 29799
|
| Hospital Charge Code |
84208210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$68.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.70
|
|
|
POD BELOW KNEE CAST
|
Facility
|
OP
|
$1,360.45
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
84208175
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$1,205.35 |
| Rate for Payer: Aetna Commercial |
$903.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,076.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,205.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,205.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$332.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,205.35
|
| Rate for Payer: Cigna Commercial |
$666.07
|
| Rate for Payer: Cigna Medicare Advantage |
$332.28
|
| Rate for Payer: Clover Medicare Advantage |
$315.67
|
| Rate for Payer: EmblemHealth Commercial |
$996.84
|
| Rate for Payer: Humana Medicare Advantage |
$342.25
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$332.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$353.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.64
|
|
|
POD BIOPSY SKIN
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS 11100
|
| Hospital Charge Code |
84208035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.20
|
|
|
POD BIOPSY SKIN
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS 11100
|
| Hospital Charge Code |
84208035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$246.24
|
| Rate for Payer: Aetna Medicare Advantage |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$165.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$165.24
|
| 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 |
$165.24
|
| Rate for Payer: Cigna Commercial |
$324.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$168.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.48
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,037.98
|
|
|
POD DEB CALLUS 2, 3, 4
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
84208025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.55 |
| Max. Negotiated Rate |
$89.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.55
|
|
|
POD DEB CALLUS 2, 3, 4
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
84208025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16.95 |
| 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 |
$155.22
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.95
|
|
|
POD DEB CALLUS 5+
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
84208030
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$29.11 |
| 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 |
$266.50
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.11
|
|
|
POD DEB CALLUS 5+
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
84208030
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$153.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
|
|
POD DEB CALLUS I
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
84208020
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.81 |
| 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 |
$31.20
|
| 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 |
$153.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$88.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.81
|
|
