|
FACTOR V (LEIDON) MUTATION
|
Facility
|
IP
|
$167.25
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
3004168
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$25.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.09
|
|
|
FACTOR X
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
38478044
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$151.50 |
| 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 |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.61
|
| Rate for Payer: Cigna Commercial |
$151.50
|
| 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 |
$90.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.45
|
| 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 |
$8.03
|
|
|
FACTOR X
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
38478044
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$45.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.45
|
|
|
FACTOR X ACTIVITY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
39900349
|
|
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 |
$52.27
|
| 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 X ACTIVITY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
39900349
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
FACTOR X,FUNCTIONAL
|
Facility
|
IP
|
$123.05
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
39900160
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$18.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.46
|
|
|
FACTOR X,FUNCTIONAL
|
Facility
|
OP
|
$123.05
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
39900160
|
|
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 |
$52.27
|
| 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 XI
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
38478047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$41.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.70
|
|
|
FACTOR XI
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
38478047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$139.00 |
| 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 |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.61
|
| Rate for Payer: Cigna Commercial |
$139.00
|
| 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 |
$83.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.70
|
| 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 |
$7.37
|
|
|
FACTOR XI ACTIVITY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
39900350
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
FACTOR XI ACTIVITY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
39900350
|
|
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 |
$52.27
|
| 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 XI ASSAY
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
3004223
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.60
|
|
|
FACTOR XI ASSAY
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
3004223
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.94 |
| 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 |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.61
|
| Rate for Payer: Cigna Commercial |
$112.00
|
| 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 |
$67.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.60
|
| 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 |
$5.94
|
|
|
FACTOR XI,FUNCTIONAL
|
Facility
|
OP
|
$123.05
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
39900161
|
|
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 |
$52.27
|
| 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 XI,FUNCTIONAL
|
Facility
|
IP
|
$123.05
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
39900161
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$18.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.46
|
|
|
FACTOR XII
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
38478050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Commercial |
$52.63
|
| Rate for Payer: Aetna Medicare Advantage |
$62.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$69.85
|
| Rate for Payer: Cigna Commercial |
$149.50
|
| Rate for Payer: Cigna Medicare Advantage |
$19.35
|
| Rate for Payer: Clover Medicare Advantage |
$18.38
|
| Rate for Payer: EmblemHealth Commercial |
$58.05
|
| Rate for Payer: Humana Medicare Advantage |
$19.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.35
|
| 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 |
$15.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.92
|
|
|
FACTOR XII
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
38478050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.85
|
|
|
FACTOR XII ACTIVITY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
39900351
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
FACTOR XII ACTIVITY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
39900351
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$52.63
|
| Rate for Payer: Aetna Medicare Advantage |
$62.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$69.85
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$19.35
|
| Rate for Payer: Clover Medicare Advantage |
$18.38
|
| Rate for Payer: EmblemHealth Commercial |
$58.05
|
| Rate for Payer: Humana Medicare Advantage |
$19.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.35
|
| 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 |
$15.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
FACTOR XII ASSAY
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
3004231
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$52.63
|
| Rate for Payer: Aetna Medicare Advantage |
$62.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$69.85
|
| Rate for Payer: Cigna Commercial |
$112.00
|
| Rate for Payer: Cigna Medicare Advantage |
$19.35
|
| Rate for Payer: Clover Medicare Advantage |
$18.38
|
| Rate for Payer: EmblemHealth Commercial |
$58.05
|
| Rate for Payer: Humana Medicare Advantage |
$19.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.94
|
|
|
FACTOR XII ASSAY
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
3004231
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.60
|
|
|
FACTOR XII,FUNCTIONAL
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
39900162
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.95
|
|
|
FACTOR XII,FUNCTIONAL
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
39900162
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$52.63
|
| Rate for Payer: Aetna Medicare Advantage |
$62.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$69.85
|
| Rate for Payer: Cigna Commercial |
$66.50
|
| Rate for Payer: Cigna Medicare Advantage |
$19.35
|
| Rate for Payer: Clover Medicare Advantage |
$18.38
|
| Rate for Payer: EmblemHealth Commercial |
$58.05
|
| Rate for Payer: Humana Medicare Advantage |
$19.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.52
|
|
|
FACTOR XIII
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85290
|
| Hospital Charge Code |
38478053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
FACTOR XIII
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85290
|
| Hospital Charge Code |
38478053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$44.44
|
| Rate for Payer: Aetna Medicare Advantage |
$52.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.98
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.34
|
| Rate for Payer: Clover Medicare Advantage |
$15.52
|
| Rate for Payer: EmblemHealth Commercial |
$49.02
|
| Rate for Payer: Humana Medicare Advantage |
$16.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.34
|
| 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 |
$13.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
