|
ELECTROHYDRAULLIC LITH PROBE
|
Facility
|
OP
|
$5,775.00
|
|
| Hospital Charge Code |
270652097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.18 |
| Max. Negotiated Rate |
$2,887.50 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,732.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,472.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,472.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,472.62
|
| Rate for Payer: Cigna Commercial |
$2,887.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,732.50
|
| Rate for Payer: Oxford Commercial |
$1,155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$866.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,155.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$139.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$153.04
|
|
|
ELECTROLYTES
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
38472008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
|
|
ELECTROLYTES
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
38472008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$125.50 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna Medicare Advantage |
$22.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.30
|
| Rate for Payer: Cigna Commercial |
$125.50
|
| Rate for Payer: Cigna Medicare Advantage |
$7.01
|
| Rate for Payer: Clover Medicare Advantage |
$6.66
|
| Rate for Payer: EmblemHealth Commercial |
$21.03
|
| Rate for Payer: Humana Medicare Advantage |
$7.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.65
|
|
|
ELECTROLYTES QN FECES
|
Facility
|
OP
|
$77.65
|
|
|
Service Code
|
HCPCS 82438
|
| Hospital Charge Code |
3009993
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: Aetna Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.05
|
| Rate for Payer: Cigna Commercial |
$38.83
|
| Rate for Payer: Cigna Medicare Advantage |
$5.00
|
| Rate for Payer: Clover Medicare Advantage |
$4.75
|
| Rate for Payer: EmblemHealth Commercial |
$15.00
|
| Rate for Payer: Humana Medicare Advantage |
$5.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.06
|
|
|
ELECTROLYTES QN FECES
|
Facility
|
IP
|
$77.65
|
|
|
Service Code
|
HCPCS 82438
|
| Hospital Charge Code |
3009993
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.65
|
|
|
ELECTROLYTES, SERUM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
3001138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna Medicare Advantage |
$22.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.30
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$7.01
|
| Rate for Payer: Clover Medicare Advantage |
$6.66
|
| Rate for Payer: EmblemHealth Commercial |
$21.03
|
| Rate for Payer: Humana Medicare Advantage |
$7.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.01
|
| 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 |
$5.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
ELECTROLYTES, SERUM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
3001138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ELECTROLYTES SERUM PANEL***
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
3001138P
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna Medicare Advantage |
$22.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.30
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: Cigna Medicare Advantage |
$7.01
|
| Rate for Payer: Clover Medicare Advantage |
$6.66
|
| Rate for Payer: EmblemHealth Commercial |
$21.03
|
| Rate for Payer: Humana Medicare Advantage |
$7.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.45
|
|
|
ELECTROLYTES SERUM PANEL***
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
3001138P
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.55
|
|
|
ELECTROLYTES (STOOL)
|
Facility
|
IP
|
$77.65
|
|
|
Service Code
|
HCPCS 82438
|
| Hospital Charge Code |
3009917
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.65
|
|
|
ELECTROLYTES (STOOL)
|
Facility
|
OP
|
$77.65
|
|
|
Service Code
|
HCPCS 82438
|
| Hospital Charge Code |
3009917
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: Aetna Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.05
|
| Rate for Payer: Cigna Commercial |
$38.83
|
| Rate for Payer: Cigna Medicare Advantage |
$5.00
|
| Rate for Payer: Clover Medicare Advantage |
$4.75
|
| Rate for Payer: EmblemHealth Commercial |
$15.00
|
| Rate for Payer: Humana Medicare Advantage |
$5.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.06
|
|
|
ELECTRONIC COMPATIBILITY EACH
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86923
|
| Hospital Charge Code |
3100191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
ELECTRONIC COMPATIBILITY EACH
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86923
|
| Hospital Charge Code |
3100191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$730.60 |
| Rate for Payer: Aetna Commercial |
$550.53
|
| Rate for Payer: Aetna Medicare Advantage |
$655.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$730.60
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$202.40
|
| Rate for Payer: Clover Medicare Advantage |
$192.28
|
| Rate for Payer: EmblemHealth Commercial |
$607.20
|
| Rate for Payer: Humana Medicare Advantage |
$208.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$202.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
ELECTRON MICROSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$976.72
|
|
|
Service Code
|
HCPCS 88348
|
| Hospital Charge Code |
38477209
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$25.88 |
| Max. Negotiated Rate |
$3,455.10 |
| Rate for Payer: Aetna Commercial |
$2,603.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,101.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,455.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,455.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$957.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,455.10
|
| Rate for Payer: Cigna Commercial |
$1,918.64
|
| Rate for Payer: Cigna Medicare Advantage |
$957.17
|
| Rate for Payer: Clover Medicare Advantage |
$909.31
|
| Rate for Payer: EmblemHealth Commercial |
$2,871.51
|
| Rate for Payer: Humana Medicare Advantage |
$985.89
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$957.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$293.02
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$397.41
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$957.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$957.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.88
|
|
|
ELECTRON MICROSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$976.72
|
|
|
Service Code
|
HCPCS 88348
|
| Hospital Charge Code |
38477209
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$146.51 |
| Max. Negotiated Rate |
$146.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.51
|
|
|
ELECTROPHORESIS, PROTEIN CSF**
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
300222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.00
|
|
|
ELECTROPHORESIS, PROTEIN CSF**
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
300222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$9.98
|
| Rate for Payer: Aetna Medicare Advantage |
$11.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.25
|
| Rate for Payer: Cigna Commercial |
$10.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.67
|
| Rate for Payer: Clover Medicare Advantage |
$3.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.01
|
| Rate for Payer: Humana Medicare Advantage |
$3.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.94
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.53
|
|
|
ELECTROPHORETIC FRACT, EACH
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3002227A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.20
|
|
|
ELECTROPHORETIC FRACT, EACH
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3002227B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.20
|
|
|
ELECTROPHORETIC FRACT, EACH
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3002227B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$29.21
|
| Rate for Payer: Aetna Medicare Advantage |
$34.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.77
|
| Rate for Payer: Cigna Commercial |
$44.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.74
|
| Rate for Payer: Clover Medicare Advantage |
$10.20
|
| Rate for Payer: EmblemHealth Commercial |
$32.22
|
| Rate for Payer: Humana Medicare Advantage |
$11.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.33
|
|
|
ELECTROPHORETIC FRACT, EACH
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3002227A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$29.21
|
| Rate for Payer: Aetna Medicare Advantage |
$34.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.77
|
| Rate for Payer: Cigna Commercial |
$44.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.74
|
| Rate for Payer: Clover Medicare Advantage |
$10.20
|
| Rate for Payer: EmblemHealth Commercial |
$32.22
|
| Rate for Payer: Humana Medicare Advantage |
$11.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.33
|
|
|
ELECTRO RESUSCITATION ONESTEP
|
Facility
|
IP
|
$344.13
|
|
| Hospital Charge Code |
270675199N
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.62 |
| Max. Negotiated Rate |
$51.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.62
|
|
|
ELECTRO RESUSCITATION ONESTEP
|
Facility
|
OP
|
$344.13
|
|
| Hospital Charge Code |
270675199N
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$172.06 |
| Rate for Payer: Aetna Commercial |
$130.77
|
| Rate for Payer: Aetna Medicare Advantage |
$103.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.75
|
| Rate for Payer: Cigna Commercial |
$172.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$103.24
|
| Rate for Payer: Oxford Commercial |
$68.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.83
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.12
|
|
|
ELECTRO RESUSCITATION ONESTEP
|
Facility
|
IP
|
$335.75
|
|
| Hospital Charge Code |
270675199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.36 |
| Max. Negotiated Rate |
$50.36 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.36
|
|
|
ELECTRO RESUSCITATION ONESTEP
|
Facility
|
OP
|
$335.75
|
|
| Hospital Charge Code |
270675199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Commercial |
$127.58
|
| Rate for Payer: Aetna Medicare Advantage |
$100.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$85.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$85.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$85.62
|
| Rate for Payer: Cigna Commercial |
$167.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.72
|
| Rate for Payer: Oxford Commercial |
$67.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$67.15
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.90
|
|
