|
FETAL NON-STRESS EA ADDTL FETU
|
Facility
|
IP
|
$1,898.40
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
74308345
|
|
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 |
74308345
|
|
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
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
IP
|
$752.25
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
73190139
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$112.84 |
| Max. Negotiated Rate |
$112.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.84
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
1800077
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
1800077
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$10.85 |
| 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 |
$135.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,301.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.93
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
OP
|
$752.25
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
73190139
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$4,601.00 |
| 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 |
$225.68
|
| Rate for Payer: Oxford Commercial |
$2,624.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,601.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.93
|
|
|
FETAL SCREEN (K-B)
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
38473124
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
|
|
FETAL SCREEN (K-B)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
38473124
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.25 |
| 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 |
$42.50
|
| 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 |
$25.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
| 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 |
$2.25
|
|
|
FETAL SCREEN,ROSETTE
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
38476278
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$853.60 |
| Rate for Payer: Aetna Commercial |
$10.42
|
| Rate for Payer: Aetna Medicare Advantage |
$12.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.83
|
| 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 |
$13.83
|
| Rate for Payer: Cigna Commercial |
$853.60
|
| Rate for Payer: Cigna Medicare Advantage |
$3.83
|
| Rate for Payer: Clover Medicare Advantage |
$3.64
|
| Rate for Payer: EmblemHealth Commercial |
$11.49
|
| Rate for Payer: Humana Medicare Advantage |
$3.94
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.62
|
|
|
FETAL SCREEN,ROSETTE
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
38476278
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.85
|
|
|
FETOMATERNAL BLEED FC
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86849
|
| Hospital Charge Code |
397043301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.45
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| 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 |
$9.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
FETOMATERNAL BLEED FC
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86849
|
| Hospital Charge Code |
397043301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
Fetoprotein (AFP), Serum, Tu
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
39888017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$45.61
|
| Rate for Payer: Aetna Medicare Advantage |
$54.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.53
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$16.77
|
| Rate for Payer: Clover Medicare Advantage |
$15.93
|
| Rate for Payer: EmblemHealth Commercial |
$50.31
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.28
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
Fetoprotein (AFP), Serum, Tu
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
39888017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$9,669.82
|
|
|
Service Code
|
APR-DRG 7223
|
| Min. Negotiated Rate |
$9,480.22 |
| Max. Negotiated Rate |
$9,669.82 |
| Rate for Payer: UnitedHealthcare Community & State |
$9,480.22
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$9,669.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9,480.22
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$30,826.01
|
|
|
Service Code
|
MSDRG 864
|
| Min. Negotiated Rate |
$9,386.12 |
| Max. Negotiated Rate |
$30,826.01 |
| Rate for Payer: Aetna Commercial |
$21,438.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30,826.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20,469.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20,469.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9,880.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20,469.68
|
| Rate for Payer: Cigna Commercial |
$16,612.42
|
| Rate for Payer: Cigna Medicare Advantage |
$9,880.13
|
| Rate for Payer: Clover Medicare Advantage |
$9,386.12
|
| Rate for Payer: EmblemHealth Commercial |
$29,640.39
|
| Rate for Payer: Humana Medicare Advantage |
$10,176.53
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9,880.13
|
| Rate for Payer: Oxford Commercial |
$11,939.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$20,936.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9,880.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$9,880.13
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$14,767.72
|
|
|
Service Code
|
APR-DRG 7224
|
| Min. Negotiated Rate |
$14,478.16 |
| Max. Negotiated Rate |
$14,767.72 |
| Rate for Payer: UnitedHealthcare Community & State |
$14,478.16
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$14,767.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14,478.16
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$4,874.49
|
|
|
Service Code
|
APR-DRG 7221
|
| Min. Negotiated Rate |
$4,778.91 |
| Max. Negotiated Rate |
$4,874.49 |
| Rate for Payer: UnitedHealthcare Community & State |
$4,778.91
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$4,874.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4,778.91
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$6,933.82
|
|
|
Service Code
|
APR-DRG 7222
|
| Min. Negotiated Rate |
$6,797.86 |
| Max. Negotiated Rate |
$6,933.82 |
| Rate for Payer: UnitedHealthcare Community & State |
$6,797.86
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$6,933.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6,797.86
|
|
|
Fexofenadine 180mg
|
Facility
|
IP
|
$6.50
|
|
|
Service Code
|
NDC 3633717
|
| Hospital Charge Code |
6063943281
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.98
|
|
|
Fexofenadine 180mg
|
Facility
|
OP
|
$6.50
|
|
|
Service Code
|
NDC 3633717
|
| Hospital Charge Code |
6063943281
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Medicare Advantage |
$1.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.66
|
| Rate for Payer: Cigna Commercial |
$3.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.95
|
| Rate for Payer: Oxford Commercial |
$1.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.17
|
|
|
FF SEMIT & GRACILLIS TENDON
|
Facility
|
IP
|
$13,375.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
270680655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,006.25 |
| Max. Negotiated Rate |
$3,236.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,675.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,236.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,942.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,006.25
|
|
|
FF SEMIT & GRACILLIS TENDON
|
Facility
|
OP
|
$13,375.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
270680655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.34 |
| Max. Negotiated Rate |
$6,687.50 |
| Rate for Payer: Aetna Commercial |
$5,082.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,012.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,410.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,410.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,410.62
|
| Rate for Payer: Cigna Commercial |
$6,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,236.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,942.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,006.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$322.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$354.44
|
|
|
FHC DENTAL REFERRAL
|
Facility
|
IP
|
$4,240.00
|
|
| Hospital Charge Code |
9400087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$636.00
|
|
|
FHC DENTAL REFERRAL
|
Facility
|
OP
|
$4,240.00
|
|
| Hospital Charge Code |
9400087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.18 |
| Max. Negotiated Rate |
$2,120.00 |
| Rate for Payer: Aetna Commercial |
$1,611.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1,272.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,081.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,081.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,081.20
|
| Rate for Payer: Cigna Commercial |
$2,120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,272.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$636.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$102.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$112.36
|
|
