|
FETAL BIOPHYSICAL WNST
|
Facility
|
OP
|
$1,724.80
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
83653085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$41.57 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$117.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$517.44
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$258.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$41.57
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.71
|
|
|
FETAL BIOPHYSICAL WNST EA ADTL
|
Facility
|
OP
|
$1,724.80
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
74308355
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$41.57 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$117.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$517.44
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$258.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$41.57
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.71
|
|
|
FETAL BIOPHYSICAL WNST EA ADTL
|
Facility
|
IP
|
$1,724.80
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
74308355
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$258.72 |
| Max. Negotiated Rate |
$258.72 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$258.72
|
|
|
FETAL BIOPHY W/O NST
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 76819
|
| Hospital Charge Code |
83653090
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$171.60
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.16
|
|
|
FETAL BIOPHY W/O NST
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 76819
|
| Hospital Charge Code |
83653090
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.80
|
|
|
FETAL BLD SAMPLING KIT
|
Facility
|
OP
|
$72.85
|
|
| Hospital Charge Code |
1801026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$36.42 |
| Rate for Payer: Aetna Commercial |
$27.68
|
| Rate for Payer: Aetna Medicare Advantage |
$21.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.58
|
| Rate for Payer: Cigna Commercial |
$36.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.86
|
| Rate for Payer: Oxford Commercial |
$14.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.57
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.93
|
|
|
FETAL BLD SAMPLING KIT
|
Facility
|
IP
|
$72.85
|
|
| Hospital Charge Code |
1801026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$10.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.93
|
|
|
FETAL CONTRACTION STRESS TEST
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
HCPCS 59020
|
| Hospital Charge Code |
1800143
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$451.20
|
|
|
FETAL CONTRACTION STRESS TEST
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
HCPCS 59020
|
| Hospital Charge Code |
1800143
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$72.49 |
| Max. Negotiated Rate |
$2,301.00 |
| Rate for Payer: Aetna Commercial |
$653.29
|
| Rate for Payer: Aetna Medicare Advantage |
$778.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$866.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$866.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$240.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$76.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$866.98
|
| Rate for Payer: Cigna Commercial |
$481.45
|
| Rate for Payer: Cigna Medicare Advantage |
$240.18
|
| Rate for Payer: Clover Medicare Advantage |
$228.17
|
| Rate for Payer: EmblemHealth Commercial |
$720.54
|
| Rate for Payer: Humana Medicare Advantage |
$247.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$240.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$902.40
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$451.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,301.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$72.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.71
|
|
|
FETAL DOPPLER ECHO COMPLETE
|
Facility
|
OP
|
$904.00
|
|
|
Service Code
|
HCPCS 76827
|
| Hospital Charge Code |
74308360
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$21.79 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$127.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.20
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.96
|
|
|
FETAL DOPPLER ECHO COMPLETE
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
HCPCS 76827
|
| Hospital Charge Code |
74308360
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$135.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.60
|
|
|
FETAL DOPPLR ECHO FOLLOW UP
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
HCPCS 76828
|
| Hospital Charge Code |
74308365
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.15 |
| Max. Negotiated Rate |
$108.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.15
|
|
|
FETAL DOPPLR ECHO FOLLOW UP
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
HCPCS 76828
|
| Hospital Charge Code |
83653110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.15 |
| Max. Negotiated Rate |
$108.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.15
|
|
|
FETAL DOPPLR ECHO FOLLOW UP
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
HCPCS 76828
|
| Hospital Charge Code |
83653110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$216.30
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.11
|
|
|
FETAL DOPPLR ECHO FOLLOW UP
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
HCPCS 76828
|
| Hospital Charge Code |
74308365
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$216.30
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.11
|
|
|
FETAL ERYTHROCYTES
|
Facility
|
OP
|
$53.20
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
39900175
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$21.03
|
| Rate for Payer: Aetna Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.90
|
| Rate for Payer: Cigna Commercial |
$26.60
|
| Rate for Payer: Cigna Medicare Advantage |
$7.73
|
| Rate for Payer: Clover Medicare Advantage |
$7.34
|
| Rate for Payer: EmblemHealth Commercial |
$23.19
|
| Rate for Payer: Humana Medicare Advantage |
$7.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.96
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.41
|
|
|
FETAL ERYTHROCYTES
|
Facility
|
IP
|
$53.20
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
39900175
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$7.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.98
|
|
|
FETAL FIBRONECTIN
|
Facility
|
IP
|
$587.25
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
3001303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.09 |
| Max. Negotiated Rate |
$88.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$88.09
|
|
|
FETAL FIBRONECTIN
|
Facility
|
IP
|
$456.15
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
38474060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.42 |
| Max. Negotiated Rate |
$68.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.42
|
|
|
FETAL FIBRONECTIN
|
Facility
|
OP
|
$587.25
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
3001303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$293.62 |
| Rate for Payer: Aetna Commercial |
$175.20
|
| Rate for Payer: Aetna Medicare Advantage |
$208.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$64.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$232.50
|
| Rate for Payer: Cigna Commercial |
$293.62
|
| Rate for Payer: Cigna Medicare Advantage |
$64.41
|
| Rate for Payer: Clover Medicare Advantage |
$61.19
|
| Rate for Payer: EmblemHealth Commercial |
$193.23
|
| Rate for Payer: Humana Medicare Advantage |
$66.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$64.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$176.18
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$88.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.53
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$64.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$64.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.56
|
|
|
FETAL FIBRONECTIN
|
Facility
|
OP
|
$456.15
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
38474060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$175.20
|
| Rate for Payer: Aetna Medicare Advantage |
$208.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$64.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$232.50
|
| Rate for Payer: Cigna Commercial |
$228.07
|
| Rate for Payer: Cigna Medicare Advantage |
$64.41
|
| Rate for Payer: Clover Medicare Advantage |
$61.19
|
| Rate for Payer: EmblemHealth Commercial |
$193.23
|
| Rate for Payer: Humana Medicare Advantage |
$66.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$64.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$136.84
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.53
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$64.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$64.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.09
|
|
|
FETAL HEMOGLOBIN (KLEIHAUER)
|
Facility
|
IP
|
$167.25
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
3100161
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$25.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.09
|
|
|
FETAL HEMOGLOBIN (KLEIHAUER)
|
Facility
|
OP
|
$167.25
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
3100161
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$21.03
|
| Rate for Payer: Aetna Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.90
|
| Rate for Payer: Cigna Commercial |
$83.62
|
| Rate for Payer: Cigna Medicare Advantage |
$7.73
|
| Rate for Payer: Clover Medicare Advantage |
$7.34
|
| Rate for Payer: EmblemHealth Commercial |
$23.19
|
| Rate for Payer: Humana Medicare Advantage |
$7.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.73
|
| 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 |
$6.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.43
|
|
|
FETAL NON-STRESS EA ADDTL FETU
|
Facility
|
IP
|
$1,898.40
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
83653015
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$284.76 |
| Max. Negotiated Rate |
$284.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.76
|
|
|
FETAL NON-STRESS EA ADDTL FETU
|
Facility
|
OP
|
$1,898.40
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
83653015
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$2,301.00 |
| Rate for Payer: Aetna Commercial |
$653.29
|
| Rate for Payer: Aetna Medicare Advantage |
$778.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$866.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$866.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$240.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$503.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$866.98
|
| Rate for Payer: Cigna Commercial |
$481.45
|
| Rate for Payer: Cigna Medicare Advantage |
$240.18
|
| Rate for Payer: Clover Medicare Advantage |
$228.17
|
| Rate for Payer: EmblemHealth Commercial |
$720.54
|
| Rate for Payer: Humana Medicare Advantage |
$247.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$240.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$569.52
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,301.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.31
|
|
