|
FACTOR II
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
38478032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.31
|
| Rate for Payer: Aetna Medicare Advantage |
$42.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.98
|
| 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 |
$46.85
|
| Rate for Payer: Cigna Commercial |
$107.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.98
|
| Rate for Payer: Clover Medicare Advantage |
$12.33
|
| Rate for Payer: EmblemHealth Commercial |
$38.94
|
| Rate for Payer: Humana Medicare Advantage |
$13.37
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.67
|
|
|
FACTOR II
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
38478032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$32.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.10
|
|
|
FACTOR II ACTIVITY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
39900344
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$35.31
|
| Rate for Payer: Aetna Medicare Advantage |
$42.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.98
|
| 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 |
$46.85
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.98
|
| Rate for Payer: Clover Medicare Advantage |
$12.33
|
| Rate for Payer: EmblemHealth Commercial |
$38.94
|
| Rate for Payer: Humana Medicare Advantage |
$13.37
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.98
|
| 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 |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
FACTOR II ACTIVITY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
39900344
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
FACTOR II DNA
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
3035993
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$237.12 |
| Rate for Payer: Aetna Commercial |
$178.68
|
| Rate for Payer: Aetna Medicare Advantage |
$212.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$237.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$237.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$65.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$237.12
|
| Rate for Payer: Cigna Commercial |
$55.50
|
| Rate for Payer: Cigna Medicare Advantage |
$65.69
|
| Rate for Payer: Clover Medicare Advantage |
$62.41
|
| Rate for Payer: EmblemHealth Commercial |
$197.07
|
| Rate for Payer: Humana Medicare Advantage |
$67.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$65.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$52.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$65.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.94
|
|
|
FACTOR II DNA
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
3035993
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
|
|
FACTOR II,FUNCTIONAL
|
Facility
|
OP
|
$89.25
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
39900155
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.31
|
| Rate for Payer: Aetna Medicare Advantage |
$42.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.98
|
| 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 |
$46.85
|
| Rate for Payer: Cigna Commercial |
$44.62
|
| Rate for Payer: Cigna Medicare Advantage |
$12.98
|
| Rate for Payer: Clover Medicare Advantage |
$12.33
|
| Rate for Payer: EmblemHealth Commercial |
$38.94
|
| Rate for Payer: Humana Medicare Advantage |
$13.37
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.77
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.37
|
|
|
FACTOR II,FUNCTIONAL
|
Facility
|
IP
|
$89.25
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
39900155
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.39
|
|
|
FACTOR III ACTIVITY
|
Facility
|
OP
|
$245.65
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
3004208
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: Aetna Medicare Advantage |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.90
|
| 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 |
$64.61
|
| Rate for Payer: Cigna Commercial |
$122.83
|
| Rate for Payer: Cigna Medicare Advantage |
$17.90
|
| Rate for Payer: Clover Medicare Advantage |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$53.70
|
| Rate for Payer: Humana Medicare Advantage |
$18.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.69
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.51
|
|
|
FACTOR III ACTIVITY
|
Facility
|
IP
|
$245.65
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
3004208
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$36.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.85
|
|
|
FACTOR II INHIBITOR I
|
Facility
|
OP
|
$283.40
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
3038092A
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: Aetna Commercial |
$35.31
|
| Rate for Payer: Aetna Medicare Advantage |
$42.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.98
|
| 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 |
$46.85
|
| Rate for Payer: Cigna Commercial |
$141.70
|
| Rate for Payer: Cigna Medicare Advantage |
$12.98
|
| Rate for Payer: Clover Medicare Advantage |
$12.33
|
| Rate for Payer: EmblemHealth Commercial |
$38.94
|
| Rate for Payer: Humana Medicare Advantage |
$13.37
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.02
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.51
|
|
|
FACTOR II INHIBITOR I
|
Facility
|
IP
|
$283.40
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
3038092A
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$42.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.51
|
|
|
FACTOR II INHIBITOR II
|
Facility
|
OP
|
$89.25
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
3038092B
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.01
|
| Rate for Payer: Aetna Medicare Advantage |
$41.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.87
|
| 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 |
$46.46
|
| Rate for Payer: Cigna Commercial |
$44.62
|
| Rate for Payer: Cigna Medicare Advantage |
$12.87
|
| Rate for Payer: Clover Medicare Advantage |
$12.23
|
| Rate for Payer: EmblemHealth Commercial |
$38.61
|
| Rate for Payer: Humana Medicare Advantage |
$13.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.77
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.37
|
|
|
FACTOR II INHIBITOR II
|
Facility
|
IP
|
$89.25
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
3038092B
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.39
|
|
|
FACTOR II INHIBITOR III
|
Facility
|
OP
|
$317.94
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
3038092C
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$158.97 |
| Rate for Payer: Aetna Commercial |
$11.67
|
| Rate for Payer: Aetna Medicare Advantage |
$13.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.29
|
| 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 |
$15.49
|
| Rate for Payer: Cigna Commercial |
$158.97
|
| Rate for Payer: Cigna Medicare Advantage |
$4.29
|
| Rate for Payer: Clover Medicare Advantage |
$4.08
|
| Rate for Payer: EmblemHealth Commercial |
$12.87
|
| Rate for Payer: Humana Medicare Advantage |
$4.42
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$95.38
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.43
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.43
|
|
|
FACTOR II INHIBITOR III
|
Facility
|
IP
|
$317.94
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
3038092C
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.69 |
| Max. Negotiated Rate |
$47.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.69
|
|
|
FACTOR II INHIBITOR IV
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
3038092D
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$10.72
|
| Rate for Payer: Aetna Medicare Advantage |
$12.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.22
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.94
|
| Rate for Payer: Clover Medicare Advantage |
$3.74
|
| Rate for Payer: EmblemHealth Commercial |
$11.82
|
| Rate for Payer: Humana Medicare Advantage |
$4.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.30
|
|
|
FACTOR II INHIBITOR IV
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
3038092D
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
FACTOR II INHIBITOR V
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
3038092E
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$10.72
|
| Rate for Payer: Aetna Medicare Advantage |
$12.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.22
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.94
|
| Rate for Payer: Clover Medicare Advantage |
$3.74
|
| Rate for Payer: EmblemHealth Commercial |
$11.82
|
| Rate for Payer: Humana Medicare Advantage |
$4.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.30
|
|
|
FACTOR II INHIBITOR V
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
3038092E
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
FACTOR II INHIBITOR VI
|
Facility
|
IP
|
$263.57
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
3038092F
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$39.54 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.54
|
|
|
FACTOR II INHIBITOR VI
|
Facility
|
OP
|
$263.57
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
3038092F
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$131.78 |
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Medicare Advantage |
$19.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.01
|
| 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 |
$21.69
|
| Rate for Payer: Cigna Commercial |
$131.78
|
| Rate for Payer: Cigna Medicare Advantage |
$6.01
|
| Rate for Payer: Clover Medicare Advantage |
$5.71
|
| Rate for Payer: EmblemHealth Commercial |
$18.03
|
| Rate for Payer: Humana Medicare Advantage |
$6.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$79.07
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.81
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.98
|
|
|
FACTOR II MUTATION, NUCLEIOTID
|
Facility
|
OP
|
$448.00
|
|
| Hospital Charge Code |
3004166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: Aetna Commercial |
$170.24
|
| Rate for Payer: Aetna Medicare Advantage |
$134.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.24
|
| Rate for Payer: Cigna Commercial |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.87
|
|
|
FACTOR II MUTATION, NUCLEIOTID
|
Facility
|
IP
|
$448.00
|
|
| Hospital Charge Code |
3004166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.20
|
|
|
FACTOR II PLASMA
|
Facility
|
IP
|
$283.40
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
3004165
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$42.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.51
|
|
