|
ENALAPRIL 5 MG TAB
|
Facility
|
IP
|
$9.65
|
|
| Hospital Charge Code |
6024186
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
|
|
ENALAPRIL 5 MG TAB
|
Facility
|
OP
|
$9.65
|
|
| Hospital Charge Code |
6024186
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna Medicare Advantage |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.90
|
| Rate for Payer: Oxford Commercial |
$1.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.93
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.26
|
|
|
enalaprilat
|
Facility
|
OP
|
$10.01
|
|
| Hospital Charge Code |
6063943301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Aetna Medicare Advantage |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.55
|
| Rate for Payer: Cigna Commercial |
$5.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.00
|
| Rate for Payer: Oxford Commercial |
$2.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.27
|
|
|
enalaprilat
|
Facility
|
IP
|
$10.01
|
|
| Hospital Charge Code |
6063943301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.50
|
|
|
ENA SCREEN ANTI EXTRACTABLE AB
|
Facility
|
OP
|
$143.99
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3007960
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: Aetna Medicare Advantage |
$58.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.72
|
| Rate for Payer: Cigna Commercial |
$72.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.93
|
| Rate for Payer: Clover Medicare Advantage |
$17.03
|
| Rate for Payer: EmblemHealth Commercial |
$53.79
|
| Rate for Payer: Humana Medicare Advantage |
$18.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.82
|
|
|
ENA SCREEN ANTI EXTRACTABLE AB
|
Facility
|
IP
|
$143.99
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3007960
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.60
|
|
|
ENCEPHALITIS ANTIBODIES
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
38476025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna Commercial |
$40.77
|
| Rate for Payer: Aetna Medicare Advantage |
$48.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.11
|
| Rate for Payer: Cigna Commercial |
$137.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.99
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.26
|
|
|
ENCEPHALITIS ANTIBODIES
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
38476025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.10 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.10
|
|
|
ENCEPHALITIS, CALFORNIA
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86651
|
| Hospital Charge Code |
38478087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
|
|
ENCEPHALITIS, CALFORNIA
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86651
|
| Hospital Charge Code |
38478087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$46.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.46
|
|
|
ENCEPHALITIS CALIFORNIA
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86651
|
| Hospital Charge Code |
38479411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
|
|
ENCEPHALITIS CALIFORNIA
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86651
|
| Hospital Charge Code |
38479411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$46.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.46
|
|
|
ENCEPHALITIS EAST, EQUINE
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86652
|
| Hospital Charge Code |
38478088
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$46.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.46
|
|
|
ENCEPHALITIS EAST, EQUINE
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86652
|
| Hospital Charge Code |
38478088
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
|
|
ENCEPHALITIS EAST,EQUINE
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86652
|
| Hospital Charge Code |
38479412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$46.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.46
|
|
|
ENCEPHALITIS EAST,EQUINE
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86652
|
| Hospital Charge Code |
38479412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
|
|
ENCEPHALITIS,ST LOUIS
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86653
|
| Hospital Charge Code |
38478089
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
|
|
ENCEPHALITIS,ST LOUIS
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86653
|
| Hospital Charge Code |
38478089
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$46.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.46
|
|
|
ENCEPHALITIS,ST LOUIS
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86653
|
| Hospital Charge Code |
38479413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
|
|
ENCEPHALITIS,ST LOUIS
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86653
|
| Hospital Charge Code |
38479413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$46.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.46
|
|
|
ENCEPHALITIS, WEST EQUINE
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86654
|
| Hospital Charge Code |
38479414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
|
|
ENCEPHALITIS, WEST EQUINE
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86654
|
| Hospital Charge Code |
38478090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
|
|
ENCEPHALITIS, WEST EQUINE
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86654
|
| Hospital Charge Code |
38478090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$46.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.46
|
|
|
ENCEPHALITIS, WEST EQUINE
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86654
|
| Hospital Charge Code |
38479414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$46.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.46
|
|
|
ENCOMPASS 12MM HA COATED IMPLA
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.10 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$4,180.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,805.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,805.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,805.00
|
| Rate for Payer: Cigna Commercial |
$5,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,662.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$265.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$291.50
|
|