|
FACTOR VII
|
Facility
|
OP
|
$167.25
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
3004181
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.43 |
| 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 |
$83.62
|
| 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 |
$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 |
$14.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.43
|
|
|
FACTOR VII
|
Facility
|
IP
|
$167.25
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
3004181
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$25.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.09
|
|
|
FACTOR VII ACTIVITY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
39900346
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
FACTOR VII ACTIVITY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
39900346
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$195.00
|
| 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 |
$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 |
$14.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
FACTOR VII-CLOTTING
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
38478038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$149.50 |
| 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 |
$149.50
|
| 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 |
$89.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.85
|
| 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 |
$7.92
|
|
|
FACTOR VII-CLOTTING
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
38478038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.85
|
|
|
FACTOR VII,FUNCTIONAL
|
Facility
|
IP
|
$123.05
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
39900157
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$18.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.46
|
|
|
FACTOR VII,FUNCTIONAL
|
Facility
|
OP
|
$123.05
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
39900157
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.26 |
| 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 |
$61.52
|
| 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 |
$36.91
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.46
|
| 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 |
$3.26
|
|
|
FACTOR VIII ACTIVITY
|
Facility
|
IP
|
$245.65
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
3004209
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$36.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.85
|
|
|
FACTOR VIII ACTIVITY
|
Facility
|
OP
|
$245.65
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
3004209
|
|
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 VIII ANTIGEN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85244
|
| Hospital Charge Code |
397073169
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
FACTOR VIII ANTIGEN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85244
|
| Hospital Charge Code |
397073169
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$55.54
|
| Rate for Payer: Aetna Medicare Advantage |
$66.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$73.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$73.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$73.71
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.42
|
| Rate for Payer: Clover Medicare Advantage |
$19.40
|
| Rate for Payer: EmblemHealth Commercial |
$61.26
|
| Rate for Payer: Humana Medicare Advantage |
$21.03
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.42
|
| 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 |
$16.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
FACTOR VIII ASSAY
|
Facility
|
IP
|
$245.65
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
3004207
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$36.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.85
|
|
|
FACTOR VIII ASSAY
|
Facility
|
OP
|
$245.65
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
3004207
|
|
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 VIII,FUNCTIONAL
|
Facility
|
IP
|
$123.05
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
39900158
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$18.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.46
|
|
|
FACTOR VIII,FUNCTIONAL
|
Facility
|
OP
|
$123.05
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
39900158
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.26 |
| 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 |
$61.52
|
| 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 |
$36.91
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.46
|
| 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 |
$3.26
|
|
|
FACTOR VIII,ONE STAGE
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
38478059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$126.00 |
| 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 |
$126.00
|
| 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 |
$75.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.80
|
| 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 |
$6.68
|
|
|
FACTOR VIII,ONE STAGE
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
38479462
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$45.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.75
|
|
|
FACTOR VIII,ONE STAGE
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
38479462
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$152.50 |
| 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 |
$152.50
|
| 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 |
$91.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.75
|
| 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 |
$8.08
|
|
|
FACTOR VIII,ONE STAGE
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
38478059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.80
|
|
|
FACTOR VIII PORCINE INHIBITOR
|
Facility
|
OP
|
$89.25
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
3035065
|
|
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 VIII PORCINE INHIBITOR
|
Facility
|
IP
|
$89.25
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
3035065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.39
|
|
|
FACTOR V (LEIDEN) MUTATIO
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
39900017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$264.84 |
| Rate for Payer: Aetna Commercial |
$199.57
|
| Rate for Payer: Aetna Medicare Advantage |
$237.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$264.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$264.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$264.84
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$73.37
|
| Rate for Payer: Clover Medicare Advantage |
$69.70
|
| Rate for Payer: EmblemHealth Commercial |
$220.11
|
| Rate for Payer: Humana Medicare Advantage |
$75.57
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$73.37
|
| 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 |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$58.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$73.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
FACTOR V (LEIDEN) MUTATIO
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
39900017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
FACTOR V (LEIDON) MUTATION
|
Facility
|
OP
|
$167.25
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
3004168
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$264.84 |
| Rate for Payer: Aetna Commercial |
$199.57
|
| Rate for Payer: Aetna Medicare Advantage |
$237.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$264.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$264.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$264.84
|
| Rate for Payer: Cigna Commercial |
$83.62
|
| Rate for Payer: Cigna Medicare Advantage |
$73.37
|
| Rate for Payer: Clover Medicare Advantage |
$69.70
|
| Rate for Payer: EmblemHealth Commercial |
$220.11
|
| Rate for Payer: Humana Medicare Advantage |
$75.57
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$73.37
|
| 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 |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$58.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$73.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.43
|
|
