|
CYSTIC FIBROSIS EXPANDED SCRN
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
3038551
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,513.95
|
| Rate for Payer: Aetna Medicare Advantage |
$1,803.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,009.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,009.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$556.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,009.16
|
| Rate for Payer: Cigna Commercial |
$3,000.00
|
| Rate for Payer: Cigna Medicare Advantage |
$556.60
|
| Rate for Payer: Clover Medicare Advantage |
$528.77
|
| Rate for Payer: EmblemHealth Commercial |
$1,669.80
|
| Rate for Payer: Humana Medicare Advantage |
$573.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$556.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,800.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$445.28
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$556.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$556.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$159.00
|
|
|
Cystic Fibrosis Intron Poly-T
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 81224
|
| Hospital Charge Code |
39708017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
|
|
Cystic Fibrosis Intron Poly-T
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 81224
|
| Hospital Charge Code |
39708017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$609.14 |
| Rate for Payer: Aetna Commercial |
$459.00
|
| Rate for Payer: Aetna Medicare Advantage |
$546.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$609.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$609.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$609.14
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Cigna Medicare Advantage |
$168.75
|
| Rate for Payer: Clover Medicare Advantage |
$160.31
|
| Rate for Payer: EmblemHealth Commercial |
$506.25
|
| Rate for Payer: Humana Medicare Advantage |
$173.81
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$168.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$120.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$135.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$168.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.60
|
|
|
CYSTIC FIBROSIS PANEL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
3036006EX
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CYSTIC FIBROSIS PANEL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
3036006EX
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$2,009.16 |
| Rate for Payer: Aetna Commercial |
$1,513.95
|
| Rate for Payer: Aetna Medicare Advantage |
$1,803.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,009.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,009.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$556.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,009.16
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$556.60
|
| Rate for Payer: Clover Medicare Advantage |
$528.77
|
| Rate for Payer: EmblemHealth Commercial |
$1,669.80
|
| Rate for Payer: Humana Medicare Advantage |
$573.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$556.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$445.28
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$556.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$556.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CYSTIC FIBROSIS PROFILE.
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
3009345
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$2,009.16 |
| Rate for Payer: Aetna Commercial |
$1,513.95
|
| Rate for Payer: Aetna Medicare Advantage |
$1,803.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,009.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,009.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$556.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,009.16
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: Cigna Medicare Advantage |
$556.60
|
| Rate for Payer: Clover Medicare Advantage |
$528.77
|
| Rate for Payer: EmblemHealth Commercial |
$1,669.80
|
| Rate for Payer: Humana Medicare Advantage |
$573.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$556.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$445.28
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$556.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$556.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.41
|
|
|
CYSTIC FIBROSIS PROFILE.
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
3009345
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$18,156.11
|
|
|
Service Code
|
APR-DRG 1312
|
| Min. Negotiated Rate |
$17,800.11 |
| Max. Negotiated Rate |
$18,156.11 |
| Rate for Payer: UnitedHealthcare Community & State |
$17,800.11
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$18,156.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17,800.11
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$13,838.26
|
|
|
Service Code
|
APR-DRG 1311
|
| Min. Negotiated Rate |
$13,566.92 |
| Max. Negotiated Rate |
$13,838.26 |
| Rate for Payer: UnitedHealthcare Community & State |
$13,566.92
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$13,838.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13,566.92
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$24,603.46
|
|
|
Service Code
|
APR-DRG 1313
|
| Min. Negotiated Rate |
$24,121.04 |
| Max. Negotiated Rate |
$24,603.46 |
| Rate for Payer: UnitedHealthcare Community & State |
$24,121.04
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$24,603.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24,121.04
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$31,939.44
|
|
|
Service Code
|
APR-DRG 1314
|
| Min. Negotiated Rate |
$31,313.18 |
| Max. Negotiated Rate |
$31,939.44 |
| Rate for Payer: UnitedHealthcare Community & State |
$31,313.18
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$31,939.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31,313.18
|
|
|
CYSTINE
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
HCPCS 82139
|
| Hospital Charge Code |
38473102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna Commercial |
$45.89
|
| Rate for Payer: Aetna Medicare Advantage |
$54.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.90
|
| Rate for Payer: Cigna Commercial |
$323.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.87
|
| Rate for Payer: Clover Medicare Advantage |
$16.03
|
| Rate for Payer: EmblemHealth Commercial |
$50.61
|
| Rate for Payer: Humana Medicare Advantage |
$17.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.12
|
|
|
CYSTINE
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
HCPCS 82139
|
| Hospital Charge Code |
38473102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.90
|
|
|
CYSTINE BLOOD****
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3001039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.50
|
|
|
CYSTINE BLOOD****
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3001039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$62.51
|
| Rate for Payer: Aetna Medicare Advantage |
$74.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.95
|
| Rate for Payer: Cigna Commercial |
$35.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.98
|
| Rate for Payer: Clover Medicare Advantage |
$21.83
|
| Rate for Payer: EmblemHealth Commercial |
$68.94
|
| Rate for Payer: Humana Medicare Advantage |
$23.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.85
|
|
|
CYSTINE/HOMOCYSTINE (URINE)
|
Facility
|
OP
|
$39.25
|
|
|
Service Code
|
HCPCS 82615
|
| Hospital Charge Code |
3030442
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$25.98
|
| Rate for Payer: Aetna Medicare Advantage |
$30.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.47
|
| Rate for Payer: Cigna Commercial |
$19.62
|
| Rate for Payer: Cigna Medicare Advantage |
$9.55
|
| Rate for Payer: Clover Medicare Advantage |
$9.07
|
| Rate for Payer: EmblemHealth Commercial |
$28.65
|
| Rate for Payer: Humana Medicare Advantage |
$9.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.78
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.04
|
|
|
CYSTINE/HOMOCYSTINE (URINE)
|
Facility
|
IP
|
$39.25
|
|
|
Service Code
|
HCPCS 82615
|
| Hospital Charge Code |
3030442
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$5.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.89
|
|
|
CYSTINE PLASMA
|
Facility
|
IP
|
$153.65
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3009340
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.05
|
|
|
CYSTINE PLASMA
|
Facility
|
OP
|
$153.65
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3009340
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$62.51
|
| Rate for Payer: Aetna Medicare Advantage |
$74.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.95
|
| Rate for Payer: Cigna Commercial |
$76.83
|
| Rate for Payer: Cigna Medicare Advantage |
$22.98
|
| Rate for Payer: Clover Medicare Advantage |
$21.83
|
| Rate for Payer: EmblemHealth Commercial |
$68.94
|
| Rate for Payer: Humana Medicare Advantage |
$23.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.09
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.07
|
|
|
CYSTINE,QUALITATIVE URINE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3009342
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$62.51
|
| Rate for Payer: Aetna Medicare Advantage |
$74.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.95
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.98
|
| Rate for Payer: Clover Medicare Advantage |
$21.83
|
| Rate for Payer: EmblemHealth Commercial |
$68.94
|
| Rate for Payer: Humana Medicare Advantage |
$23.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CYSTINE,QUALITATIVE URINE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3009342
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CYSTINE,URINE
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
38473103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.90
|
|
|
CYSTINE,URINE
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
38473103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna Commercial |
$62.51
|
| Rate for Payer: Aetna Medicare Advantage |
$74.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.95
|
| Rate for Payer: Cigna Commercial |
$323.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.98
|
| Rate for Payer: Clover Medicare Advantage |
$21.83
|
| Rate for Payer: EmblemHealth Commercial |
$68.94
|
| Rate for Payer: Humana Medicare Advantage |
$23.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.12
|
|
|
CYSTLITHTMY W REM STNE WVN RES
|
Facility
|
IP
|
$23,841.70
|
|
|
Service Code
|
HCPCS 51050
|
| Hospital Charge Code |
1600000509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,576.26 |
| Max. Negotiated Rate |
$3,576.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,576.26
|
|
|
CYSTLITHTMY W REM STNE WVN RES
|
Facility
|
OP
|
$23,841.70
|
|
|
Service Code
|
HCPCS 51050
|
| Hospital Charge Code |
1600000509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$574.58 |
| Max. Negotiated Rate |
$22,993.64 |
| Rate for Payer: Aetna Commercial |
$17,326.29
|
| Rate for Payer: Aetna Medicare Advantage |
$20,638.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22,993.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22,993.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,369.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22,993.64
|
| Rate for Payer: Cigna Commercial |
$12,768.54
|
| Rate for Payer: Cigna Medicare Advantage |
$6,369.96
|
| Rate for Payer: Clover Medicare Advantage |
$6,051.46
|
| Rate for Payer: EmblemHealth Commercial |
$19,109.88
|
| Rate for Payer: Humana Medicare Advantage |
$6,561.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,369.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,152.51
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,576.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$574.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,369.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,369.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$631.81
|
|
