|
REM P SEGMENT INSTRUMENT
|
Facility
|
OP
|
$11,058.29
|
|
|
Service Code
|
HCPCS 22852
|
| Hospital Charge Code |
16000810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$314.06 |
| Max. Negotiated Rate |
$31,271.12 |
| Rate for Payer: Aetna Commercial |
$23,447.95
|
| Rate for Payer: Aetna Medicare Advantage |
$27,930.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31,271.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31,271.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8,620.57
|
| 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 |
$31,271.12
|
| Rate for Payer: Cigna Commercial |
$17,279.91
|
| Rate for Payer: Cigna Medicare Advantage |
$8,620.57
|
| Rate for Payer: Clover Medicare Advantage |
$8,189.54
|
| Rate for Payer: EmblemHealth Commercial |
$25,861.71
|
| Rate for Payer: Humana Medicare Advantage |
$8,879.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8,620.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,875.16
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,658.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$349.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8,620.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$8,620.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$314.06
|
|
|
REM P SEGMENT INSTRUMENT
|
Facility
|
IP
|
$11,058.29
|
|
|
Service Code
|
HCPCS 22852
|
| Hospital Charge Code |
16000810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,658.74 |
| Max. Negotiated Rate |
$1,658.74 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,658.74
|
|
|
REM&REPL NEPHROURET STENT
|
Facility
|
IP
|
$6,757.27
|
|
|
Service Code
|
HCPCS 50387
|
| Hospital Charge Code |
7412031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,013.59 |
| Max. Negotiated Rate |
$1,013.59 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,013.59
|
|
|
REM&REPL NEPHROURET STENT
|
Facility
|
OP
|
$6,757.27
|
|
|
Service Code
|
HCPCS 50387
|
| Hospital Charge Code |
7412031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$191.91 |
| Max. Negotiated Rate |
$9,008.64 |
| Rate for Payer: Aetna Commercial |
$6,754.93
|
| Rate for Payer: Aetna Medicare Advantage |
$8,046.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,008.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,008.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,483.43
|
| 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 |
$9,008.64
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: Cigna Medicare Advantage |
$2,483.43
|
| Rate for Payer: Clover Medicare Advantage |
$2,359.26
|
| Rate for Payer: EmblemHealth Commercial |
$7,450.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,557.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,483.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,756.89
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,013.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$213.53
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$191.91
|
|
|
REM/REV LONG ARM/LEG CAST
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 29705
|
| Hospital Charge Code |
5780160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$68.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.70
|
|
|
REM/REV LONG ARM/LEG CAST
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 29705
|
| Hospital Charge Code |
5780160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.01 |
| 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 |
$40.34
|
| 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 |
$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 |
$332.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.01
|
|
|
REM SUBQ CARD RHYTHM MONITOR
|
Facility
|
IP
|
$3,396.55
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
366833286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$509.48 |
| Max. Negotiated Rate |
$509.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$509.48
|
|
|
REM SUBQ CARD RHYTHM MONITOR
|
Facility
|
OP
|
$3,396.55
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
403433286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$3,629.00 |
| 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 |
$3,536.00
|
| 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 |
$883.10
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$509.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$107.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.46
|
|
|
REM SUBQ CARD RHYTHM MONITOR
|
Facility
|
IP
|
$3,396.55
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
411033286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$509.48 |
| Max. Negotiated Rate |
$509.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$509.48
|
|
|
REM SUBQ CARD RHYTHM MONITOR
|
Facility
|
OP
|
$3,396.55
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
366833286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$3,629.00 |
| 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 |
$3,536.00
|
| 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 |
$883.10
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$509.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$107.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.46
|
|
|
REM SUBQ CARD RHYTHM MONITOR
|
Facility
|
OP
|
$3,396.55
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
411033286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$3,629.00 |
| 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 |
$3,536.00
|
| 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 |
$883.10
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$509.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$107.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.46
|
|
|
REM SUBQ CARD RHYTHM MONITOR
|
Facility
|
IP
|
$3,396.55
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
403433286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$509.48 |
| Max. Negotiated Rate |
$509.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$509.48
|
|
|
REM SUTURE W AN,OS
|
Facility
|
OP
|
$3,264.00
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
1600000293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.70 |
| 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 |
$848.64
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$489.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$103.14
|
| 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 |
$92.70
|
|
|
REM SUTURE W AN,OS
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
1600000293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$489.60
|
|
|
REM SUTURE W AN,SS
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS 15850
|
| Hospital Charge Code |
16000601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$489.60
|
|
|
REM SUTURE W AN,SS
|
Facility
|
OP
|
$3,264.00
|
|
|
Service Code
|
HCPCS 15850
|
| Hospital Charge Code |
16000601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,240.32
|
| Rate for Payer: Aetna Medicare Advantage |
$979.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$832.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$832.32
|
| 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 |
$832.32
|
| Rate for Payer: Cigna Commercial |
$1,632.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$848.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$489.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$103.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$92.70
|
|
|
REM TOT KNEE PROSTH METHLMETH
|
Facility
|
IP
|
$13,561.50
|
|
|
Service Code
|
HCPCS 27488
|
| Hospital Charge Code |
1600000421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,034.22 |
| Max. Negotiated Rate |
$2,034.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,034.22
|
|
|
REM TOT KNEE PROSTH METHLMETH
|
Facility
|
OP
|
$13,561.50
|
|
|
Service Code
|
HCPCS 27488
|
| Hospital Charge Code |
1600000421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.15 |
| Max. Negotiated Rate |
$55,329.13 |
| Rate for Payer: Aetna Commercial |
$41,487.32
|
| Rate for Payer: Aetna Medicare Advantage |
$49,418.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55,329.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55,329.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15,252.69
|
| 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 |
$55,329.13
|
| Rate for Payer: Cigna Commercial |
$30,573.98
|
| Rate for Payer: Cigna Medicare Advantage |
$15,252.69
|
| Rate for Payer: Clover Medicare Advantage |
$14,490.06
|
| Rate for Payer: EmblemHealth Commercial |
$45,758.07
|
| Rate for Payer: Humana Medicare Advantage |
$15,710.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15,252.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,525.99
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,034.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$428.54
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15,252.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$15,252.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$385.15
|
|
|
REM TUNN CV CATH W/PO/PUMP
|
Facility
|
IP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
323036590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$544.61 |
| Max. Negotiated Rate |
$544.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
|
|
REM TUNN CV CATH W/PO/PUMP
|
Facility
|
OP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
323036590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.11 |
| Max. Negotiated Rate |
$6,783.93 |
| Rate for Payer: Aetna Commercial |
$5,086.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6,059.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,870.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$226.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,783.93
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,870.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,776.63
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,926.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,870.14
|
| 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 |
$1,870.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$103.11
|
|
|
REM TUNNELED CVAD W PORT/PUMP
|
Facility
|
IP
|
$2,904.56
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
16000165
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$435.68 |
| Max. Negotiated Rate |
$435.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.68
|
|
|
REM TUNNELED CVAD W PORT/PUMP
|
Facility
|
OP
|
$2,904.56
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
16000165
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$6,783.93 |
| Rate for Payer: Aetna Commercial |
$5,086.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6,059.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,870.14
|
| 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 |
$6,783.93
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,870.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,776.63
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,926.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,870.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$755.19
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$91.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$82.49
|
|
|
REMVAL OF ANKLE/HEEL LESION-R
|
Facility
|
OP
|
$20,900.00
|
|
|
Service Code
|
HCPCS 28100
|
| Hospital Charge Code |
1600000589
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.56 |
| Max. Negotiated Rate |
$14,100.89 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| 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 |
$14,100.89
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,434.00
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,135.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$660.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$593.56
|
|
|
REMVAL OF ANKLE/HEEL LESION-R
|
Facility
|
IP
|
$20,900.00
|
|
|
Service Code
|
HCPCS 28100
|
| Hospital Charge Code |
1600000589
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,135.00 |
| Max. Negotiated Rate |
$3,135.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,135.00
|
|
|
REMVAL OF SPINAL LMNA SGL LMBR
|
Facility
|
IP
|
$47,548.90
|
|
|
Service Code
|
HCPCS 63047
|
| Hospital Charge Code |
16000276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,132.34 |
| Max. Negotiated Rate |
$7,132.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,132.34
|
|
