|
GROUP THERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4518521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
GROUP THERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4822521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
GROUP THERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4824521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$435.65 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare Advantage |
$391.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$120.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$435.65
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: Cigna Medicare Advantage |
$120.69
|
| Rate for Payer: Clover Medicare Advantage |
$114.66
|
| Rate for Payer: EmblemHealth Commercial |
$362.07
|
| Rate for Payer: Humana Medicare Advantage |
$124.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$120.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
GROUP THERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4546521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$435.65 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare Advantage |
$391.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$120.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$435.65
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: Cigna Medicare Advantage |
$120.69
|
| Rate for Payer: Clover Medicare Advantage |
$114.66
|
| Rate for Payer: EmblemHealth Commercial |
$362.07
|
| Rate for Payer: Humana Medicare Advantage |
$124.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$120.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
GROUP THERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4527521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$435.65 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare Advantage |
$391.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$120.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$435.65
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: Cigna Medicare Advantage |
$120.69
|
| Rate for Payer: Clover Medicare Advantage |
$114.66
|
| Rate for Payer: EmblemHealth Commercial |
$362.07
|
| Rate for Payer: Humana Medicare Advantage |
$124.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$120.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
GROUP THERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4518521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$435.65 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare Advantage |
$391.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$120.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$435.65
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: Cigna Medicare Advantage |
$120.69
|
| Rate for Payer: Clover Medicare Advantage |
$114.66
|
| Rate for Payer: EmblemHealth Commercial |
$362.07
|
| Rate for Payer: Humana Medicare Advantage |
$124.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$120.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
GROUP THERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4504521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
GROUP THERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4515521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
GROUP THERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4515521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$435.65 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare Advantage |
$391.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$120.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$435.65
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: Cigna Medicare Advantage |
$120.69
|
| Rate for Payer: Clover Medicare Advantage |
$114.66
|
| Rate for Payer: EmblemHealth Commercial |
$362.07
|
| Rate for Payer: Humana Medicare Advantage |
$124.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$120.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
GROUP THERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4535521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$435.65 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare Advantage |
$391.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$120.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$435.65
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: Cigna Medicare Advantage |
$120.69
|
| Rate for Payer: Clover Medicare Advantage |
$114.66
|
| Rate for Payer: EmblemHealth Commercial |
$362.07
|
| Rate for Payer: Humana Medicare Advantage |
$124.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$120.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
GROUP THERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4517521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
GROUP THERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4822521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$435.65 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare Advantage |
$391.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$435.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$120.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$435.65
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: Cigna Medicare Advantage |
$120.69
|
| Rate for Payer: Clover Medicare Advantage |
$114.66
|
| Rate for Payer: EmblemHealth Commercial |
$362.07
|
| Rate for Payer: Humana Medicare Advantage |
$124.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$120.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
GROUP THERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4511521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
GROUP THERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
4832521
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
GROWTH HORMONE
|
Facility
|
OP
|
$114.65
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
39900089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$45.34
|
| Rate for Payer: Aetna Medicare Advantage |
$54.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.17
|
| Rate for Payer: Cigna Commercial |
$57.33
|
| Rate for Payer: Cigna Medicare Advantage |
$16.67
|
| Rate for Payer: Clover Medicare Advantage |
$15.84
|
| Rate for Payer: EmblemHealth Commercial |
$50.01
|
| Rate for Payer: Humana Medicare Advantage |
$17.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.04
|
|
|
GROWTH HORMONE
|
Facility
|
IP
|
$114.65
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
39900089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.20
|
|
|
GROWTH HORMONE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
38472329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$45.34
|
| Rate for Payer: Aetna Medicare Advantage |
$54.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.17
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.67
|
| Rate for Payer: Clover Medicare Advantage |
$15.84
|
| Rate for Payer: EmblemHealth Commercial |
$50.01
|
| Rate for Payer: Humana Medicare Advantage |
$17.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.67
|
| 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 |
$13.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
GROWTH HORMONE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
38472329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
GROWTH HORMONE, SERUM
|
Facility
|
OP
|
$187.25
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
3001476
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$45.34
|
| Rate for Payer: Aetna Medicare Advantage |
$54.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.17
|
| Rate for Payer: Cigna Commercial |
$93.62
|
| Rate for Payer: Cigna Medicare Advantage |
$16.67
|
| Rate for Payer: Clover Medicare Advantage |
$15.84
|
| Rate for Payer: EmblemHealth Commercial |
$50.01
|
| Rate for Payer: Humana Medicare Advantage |
$17.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.17
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.96
|
|
|
GROWTH HORMONE, SERUM
|
Facility
|
IP
|
$187.25
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
3001476
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.09 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.09
|
|
|
G TUBE BALLOON REPL 16FR 6216
|
Facility
|
OP
|
$148.85
|
|
| Hospital Charge Code |
270629059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: Aetna Medicare Advantage |
$44.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.96
|
| Rate for Payer: Cigna Commercial |
$74.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.66
|
| Rate for Payer: Oxford Commercial |
$29.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.77
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.94
|
|
|
G TUBE BALLOON REPL 16FR 6216
|
Facility
|
IP
|
$148.85
|
|
| Hospital Charge Code |
270629059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$22.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.33
|
|
|
G TUBE BALLOON REPL 18FR 6218
|
Facility
|
IP
|
$136.50
|
|
| Hospital Charge Code |
270629060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.48
|
|
|
G TUBE BALLOON REPL 18FR 6218
|
Facility
|
OP
|
$136.50
|
|
| Hospital Charge Code |
270629060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Aetna Commercial |
$51.87
|
| Rate for Payer: Aetna Medicare Advantage |
$40.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.81
|
| Rate for Payer: Cigna Commercial |
$68.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.95
|
| Rate for Payer: Oxford Commercial |
$27.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.62
|
|
|
GUAIFCNESIN DM SYRUP 5ML
|
Facility
|
IP
|
$1.95
|
|
| Hospital Charge Code |
6023295
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
|
