|
DRUG TEST PRESUMP CHEM ANLYZR
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3066037
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$224.31 |
| Rate for Payer: Aetna Commercial |
$169.02
|
| Rate for Payer: Aetna Medicare Advantage |
$201.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$224.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$224.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$224.31
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$62.14
|
| Rate for Payer: Clover Medicare Advantage |
$59.03
|
| Rate for Payer: EmblemHealth Commercial |
$186.42
|
| Rate for Payer: Humana Medicare Advantage |
$64.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$62.14
|
| 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 |
$49.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$62.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$62.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
DRUG TEST PRESUMP CHEM ANLYZR
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
39990169
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
DRUG TEST PRESUMP DIR OPT OBS
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
3066035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
DRUG TEST PRESUMP DIR OPT OBS
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
3066035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$34.27
|
| Rate for Payer: Aetna Medicare Advantage |
$40.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.48
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.60
|
| Rate for Payer: Clover Medicare Advantage |
$11.97
|
| Rate for Payer: EmblemHealth Commercial |
$37.80
|
| Rate for Payer: Humana Medicare Advantage |
$12.98
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.60
|
| 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 |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.08
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
DRUG TEST PRESUMP DIR OPT OBS
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
3038545
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
DRUG TEST PRESUMP DIR OPT OBS
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
39990167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$34.27
|
| Rate for Payer: Aetna Medicare Advantage |
$40.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.48
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.60
|
| Rate for Payer: Clover Medicare Advantage |
$11.97
|
| Rate for Payer: EmblemHealth Commercial |
$37.80
|
| Rate for Payer: Humana Medicare Advantage |
$12.98
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.60
|
| 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 |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.08
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
DRUG TEST PRESUMP DIR OPT OBS
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
3038545
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$34.27
|
| Rate for Payer: Aetna Medicare Advantage |
$40.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.48
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.60
|
| Rate for Payer: Clover Medicare Advantage |
$11.97
|
| Rate for Payer: EmblemHealth Commercial |
$37.80
|
| Rate for Payer: Humana Medicare Advantage |
$12.98
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.60
|
| 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 |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.08
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
DRUG TEST PRESUMP DIR OPT OBS
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
39990167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
DRUG TEST PRESUMP INSTR ASSIST
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80306
|
| Hospital Charge Code |
3038546
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
DRUG TEST PRESUMP INSTR ASSIST
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80306
|
| Hospital Charge Code |
39990168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$46.62
|
| Rate for Payer: Aetna Medicare Advantage |
$55.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.87
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.14
|
| Rate for Payer: Clover Medicare Advantage |
$16.28
|
| Rate for Payer: EmblemHealth Commercial |
$51.42
|
| Rate for Payer: Humana Medicare Advantage |
$17.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.14
|
| 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 |
$13.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
DRUG TEST PRESUMP INSTR ASSIST
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80306
|
| Hospital Charge Code |
39990168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
DRUG TEST PRESUMP INSTR ASSIST
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80306
|
| Hospital Charge Code |
3038546
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$46.62
|
| Rate for Payer: Aetna Medicare Advantage |
$55.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.87
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.14
|
| Rate for Payer: Clover Medicare Advantage |
$16.28
|
| Rate for Payer: EmblemHealth Commercial |
$51.42
|
| Rate for Payer: Humana Medicare Advantage |
$17.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.14
|
| 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 |
$13.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
DRUG TEST PRESUMP INSTR ASSIST
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80306
|
| Hospital Charge Code |
3066036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$46.62
|
| Rate for Payer: Aetna Medicare Advantage |
$55.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.87
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.14
|
| Rate for Payer: Clover Medicare Advantage |
$16.28
|
| Rate for Payer: EmblemHealth Commercial |
$51.42
|
| Rate for Payer: Humana Medicare Advantage |
$17.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.14
|
| 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 |
$13.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
DRUG TEST PRESUMP INSTR ASSIST
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80306
|
| Hospital Charge Code |
3066036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
DRUG TOX TRAMADOL QNT URINE
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 80373
|
| Hospital Charge Code |
401080373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.26
|
|
|
DRUG TOX TRAMADOL QNT URINE
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 80373
|
| Hospital Charge Code |
401080373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
DRVVT SCREEN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
3035076B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.10
|
|
|
DRVVT SCREEN
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
3035076B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Medicare Advantage |
$20.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.35
|
| Rate for Payer: Cigna Commercial |
$27.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.47
|
| Rate for Payer: Clover Medicare Advantage |
$6.15
|
| Rate for Payer: EmblemHealth Commercial |
$19.41
|
| Rate for Payer: Humana Medicare Advantage |
$6.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.43
|
|
|
DRVVT SCR W/RFL PHOS NEUT
|
Facility
|
IP
|
$65.80
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
39900181
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.87
|
|
|
DRVVT SCR W/RFL PHOS NEUT
|
Facility
|
OP
|
$65.80
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
39900181
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$26.06
|
| Rate for Payer: Aetna Medicare Advantage |
$31.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.58
|
| Rate for Payer: Cigna Commercial |
$32.90
|
| Rate for Payer: Cigna Medicare Advantage |
$9.58
|
| Rate for Payer: Clover Medicare Advantage |
$9.10
|
| Rate for Payer: EmblemHealth Commercial |
$28.74
|
| Rate for Payer: Humana Medicare Advantage |
$9.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.74
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.74
|
|
|
DRY SEAL FLEX SHEATH
|
Facility
|
OP
|
$2,235.00
|
|
| Hospital Charge Code |
270682806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$1,117.50 |
| Rate for Payer: Aetna Commercial |
$849.30
|
| Rate for Payer: Aetna Medicare Advantage |
$670.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$569.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$569.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$569.92
|
| Rate for Payer: Cigna Commercial |
$1,117.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$670.50
|
| Rate for Payer: Oxford Commercial |
$447.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$335.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$447.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$53.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$59.23
|
|
|
DRY SEAL FLEX SHEATH
|
Facility
|
IP
|
$3,020.00
|
|
| Hospital Charge Code |
270682807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.00 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$453.00
|
|
|
DRY SEAL FLEX SHEATH
|
Facility
|
OP
|
$3,020.00
|
|
| Hospital Charge Code |
270682807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.78 |
| Max. Negotiated Rate |
$1,510.00 |
| Rate for Payer: Aetna Commercial |
$1,147.60
|
| Rate for Payer: Aetna Medicare Advantage |
$906.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$770.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$770.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$770.10
|
| Rate for Payer: Cigna Commercial |
$1,510.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$906.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$453.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$604.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$72.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$80.03
|
|
|
DRY SEAL FLEX SHEATH
|
Facility
|
IP
|
$2,235.00
|
|
| Hospital Charge Code |
270682806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$335.25 |
| Max. Negotiated Rate |
$335.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$335.25
|
|
|
DS3A001 STRL PKG ASSY,AGILIS H
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
270702512
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.00
|
| Rate for Payer: Oxford Commercial |
$50.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.62
|
|
