|
FACTOR II PLASMA
|
Facility
|
OP
|
$283.40
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
3004165
|
|
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 INHIBITOR TEST
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
38478077
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.41 |
| 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 |
$45.50
|
| 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 |
$27.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.65
|
| 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 |
$2.41
|
|
|
FACTOR INHIBITOR TEST
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
38478077
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.65
|
|
|
FACTOR INHIBITOR TEST
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
401085335
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$195.00
|
| 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 |
$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 |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
FACTOR INHIBITOR TEST
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
401085335
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
FACTOR IX
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
38478041
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$251.50 |
| Rate for Payer: Aetna Commercial |
$51.79
|
| Rate for Payer: Aetna Medicare Advantage |
$61.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.73
|
| Rate for Payer: Cigna Commercial |
$251.50
|
| Rate for Payer: Cigna Medicare Advantage |
$19.04
|
| Rate for Payer: Clover Medicare Advantage |
$18.09
|
| Rate for Payer: EmblemHealth Commercial |
$57.12
|
| Rate for Payer: Humana Medicare Advantage |
$19.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$150.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.33
|
|
|
FACTOR IX
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
38478041
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$75.45 |
| Max. Negotiated Rate |
$75.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.45
|
|
|
FACTOR IX ACTIVITY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
39900348
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
FACTOR IX ACTIVITY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
39900348
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$51.79
|
| Rate for Payer: Aetna Medicare Advantage |
$61.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.73
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$19.04
|
| Rate for Payer: Clover Medicare Advantage |
$18.09
|
| Rate for Payer: EmblemHealth Commercial |
$57.12
|
| Rate for Payer: Humana Medicare Advantage |
$19.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.04
|
| 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 |
$15.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
FACTOR IX ANTIGEN
|
Facility
|
OP
|
$1,000.35
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
401085250
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$500.18 |
| Rate for Payer: Aetna Commercial |
$51.79
|
| Rate for Payer: Aetna Medicare Advantage |
$61.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.73
|
| Rate for Payer: Cigna Commercial |
$500.18
|
| Rate for Payer: Cigna Medicare Advantage |
$19.04
|
| Rate for Payer: Clover Medicare Advantage |
$18.09
|
| Rate for Payer: EmblemHealth Commercial |
$57.12
|
| Rate for Payer: Humana Medicare Advantage |
$19.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.11
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.51
|
|
|
FACTOR IX ANTIGEN
|
Facility
|
IP
|
$1,000.35
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
401085250
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$150.05 |
| Max. Negotiated Rate |
$150.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.05
|
|
|
FACTOR IX,FUNCTIONAL
|
Facility
|
IP
|
$130.85
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
39900159
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$19.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.63
|
|
|
FACTOR IX,FUNCTIONAL
|
Facility
|
OP
|
$130.85
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
39900159
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$51.79
|
| Rate for Payer: Aetna Medicare Advantage |
$61.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.73
|
| Rate for Payer: Cigna Commercial |
$65.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.04
|
| Rate for Payer: Clover Medicare Advantage |
$18.09
|
| Rate for Payer: EmblemHealth Commercial |
$57.12
|
| Rate for Payer: Humana Medicare Advantage |
$19.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.26
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.47
|
|
|
FACTOR IX RECOMBINENT
|
Facility
|
IP
|
$5.75
|
|
| Hospital Charge Code |
60629321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.86
|
|
|
FACTOR IX RECOMBINENT
|
Facility
|
OP
|
$5.75
|
|
| Hospital Charge Code |
60629321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: Aetna Medicare Advantage |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.47
|
| Rate for Payer: Cigna Commercial |
$2.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.86
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.15
|
|
|
FACTOR V
|
Facility
|
OP
|
$448.00
|
|
| Hospital Charge Code |
3004167
|
|
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 V
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
38478035
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.60
|
|
|
FACTOR V
|
Facility
|
IP
|
$448.00
|
|
| Hospital Charge Code |
3004167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.20
|
|
|
FACTOR V
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
38478035
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$48.01
|
| Rate for Payer: Aetna Medicare Advantage |
$57.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.71
|
| Rate for Payer: Cigna Commercial |
$192.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.65
|
| Rate for Payer: Clover Medicare Advantage |
$16.77
|
| Rate for Payer: EmblemHealth Commercial |
$52.95
|
| Rate for Payer: Humana Medicare Advantage |
$18.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$115.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.12
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.18
|
|
|
FACTOR V ACTIVITY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
39900345
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$48.01
|
| Rate for Payer: Aetna Medicare Advantage |
$57.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.71
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.65
|
| Rate for Payer: Clover Medicare Advantage |
$16.77
|
| Rate for Payer: EmblemHealth Commercial |
$52.95
|
| Rate for Payer: Humana Medicare Advantage |
$18.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.65
|
| 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 |
$14.12
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
FACTOR V ACTIVITY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
39900345
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
FACTOR V ASSAY
|
Facility
|
OP
|
$167.25
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
3004173
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.01
|
| Rate for Payer: Aetna Medicare Advantage |
$57.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.71
|
| Rate for Payer: Cigna Commercial |
$83.62
|
| Rate for Payer: Cigna Medicare Advantage |
$17.65
|
| Rate for Payer: Clover Medicare Advantage |
$16.77
|
| Rate for Payer: EmblemHealth Commercial |
$52.95
|
| Rate for Payer: Humana Medicare Advantage |
$18.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.17
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.12
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.43
|
|
|
FACTOR V ASSAY
|
Facility
|
IP
|
$167.25
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
3004173
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$25.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.09
|
|
|
FACTOR V,FUNCTIONAL
|
Facility
|
OP
|
$121.30
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
39900156
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.01
|
| Rate for Payer: Aetna Medicare Advantage |
$57.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.71
|
| Rate for Payer: Cigna Commercial |
$60.65
|
| Rate for Payer: Cigna Medicare Advantage |
$17.65
|
| Rate for Payer: Clover Medicare Advantage |
$16.77
|
| Rate for Payer: EmblemHealth Commercial |
$52.95
|
| Rate for Payer: Humana Medicare Advantage |
$18.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.39
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.12
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.21
|
|
|
FACTOR V,FUNCTIONAL
|
Facility
|
IP
|
$121.30
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
39900156
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.20
|
|
