|
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC
|
Facility
|
IP
|
$907,912.86
|
|
|
Service Code
|
MSDRG 001
|
| Min. Negotiated Rate |
$276,447.82 |
| Max. Negotiated Rate |
$907,912.86 |
| Rate for Payer: Aetna Medicare Advantage |
$907,912.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$630,373.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$630,373.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$290,997.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$630,373.10
|
| Rate for Payer: Cigna Commercial |
$524,439.26
|
| Rate for Payer: Cigna Medicare Advantage |
$290,997.71
|
| Rate for Payer: Clover Medicare Advantage |
$276,447.82
|
| Rate for Payer: EmblemHealth Commercial |
$872,993.13
|
| Rate for Payer: Humana Medicare Advantage |
$299,727.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$290,997.71
|
| Rate for Payer: Oxford Commercial |
$376,921.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$660,943.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$290,997.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$290,997.71
|
|
|
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$368,396.56
|
|
|
Service Code
|
MSDRG 002
|
| Min. Negotiated Rate |
$112,172.03 |
| Max. Negotiated Rate |
$368,396.56 |
| Rate for Payer: Aetna Medicare Advantage |
$368,396.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$284,714.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$284,714.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$118,075.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$284,714.64
|
| Rate for Payer: Cigna Commercial |
$212,063.31
|
| Rate for Payer: Cigna Medicare Advantage |
$118,075.82
|
| Rate for Payer: Clover Medicare Advantage |
$112,172.03
|
| Rate for Payer: EmblemHealth Commercial |
$354,227.46
|
| Rate for Payer: Humana Medicare Advantage |
$121,618.09
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$118,075.82
|
| Rate for Payer: Oxford Commercial |
$152,412.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$267,260.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$118,075.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$118,075.82
|
|
|
HEAVY METAL QUAL ANY ANALYTES
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83015
|
| Hospital Charge Code |
39990246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEAVY METAL QUAL ANY ANALYTES
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83015
|
| Hospital Charge Code |
39990246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$56.96
|
| Rate for Payer: Aetna Medicare Advantage |
$67.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.94
|
| 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 |
$75.59
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.94
|
| Rate for Payer: Clover Medicare Advantage |
$19.89
|
| Rate for Payer: EmblemHealth Commercial |
$62.82
|
| Rate for Payer: Humana Medicare Advantage |
$21.57
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.94
|
| 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 |
$16.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEAVY METAL QUANT EA
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
401083018C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$59.73
|
| Rate for Payer: Aetna Medicare Advantage |
$71.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.27
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$21.96
|
| Rate for Payer: Clover Medicare Advantage |
$20.86
|
| Rate for Payer: EmblemHealth Commercial |
$65.88
|
| Rate for Payer: Humana Medicare Advantage |
$22.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.96
|
| 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 |
$17.57
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEAVY METAL QUANT EA
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
401083018C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEAVY METAL QUANT EACH NES
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
401083018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$59.73
|
| Rate for Payer: Aetna Medicare Advantage |
$71.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.27
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$21.96
|
| Rate for Payer: Clover Medicare Advantage |
$20.86
|
| Rate for Payer: EmblemHealth Commercial |
$65.88
|
| Rate for Payer: Humana Medicare Advantage |
$22.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.96
|
| 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 |
$17.57
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEAVY METAL QUANT EACH NES
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
401083018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEAVY METALS BLOOD I
|
Facility
|
OP
|
$130.40
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
39990142A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$51.60
|
| Rate for Payer: Aetna Medicare Advantage |
$61.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.48
|
| Rate for Payer: Cigna Commercial |
$65.20
|
| Rate for Payer: Cigna Medicare Advantage |
$18.97
|
| Rate for Payer: Clover Medicare Advantage |
$18.02
|
| Rate for Payer: EmblemHealth Commercial |
$56.91
|
| Rate for Payer: Humana Medicare Advantage |
$19.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.12
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.46
|
|
|
HEAVY METALS BLOOD I
|
Facility
|
IP
|
$130.40
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
39990142A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.56 |
| Max. Negotiated Rate |
$19.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.56
|
|
|
HEAVY METALS BLOOD II
|
Facility
|
OP
|
$83.20
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
39990142B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.94
|
| Rate for Payer: Aetna Medicare Advantage |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.71
|
| Rate for Payer: Cigna Commercial |
$41.60
|
| Rate for Payer: Cigna Medicare Advantage |
$12.11
|
| Rate for Payer: Clover Medicare Advantage |
$11.50
|
| Rate for Payer: EmblemHealth Commercial |
$36.33
|
| Rate for Payer: Humana Medicare Advantage |
$12.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.96
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.20
|
|
|
HEAVY METALS BLOOD II
|
Facility
|
IP
|
$83.20
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
39990142B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.48
|
|
|
HEAVY METALS BLOOD III
|
Facility
|
IP
|
$111.75
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
39990142C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.76
|
|
|
HEAVY METALS BLOOD III
|
Facility
|
OP
|
$111.75
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
39990142C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$44.23
|
| Rate for Payer: Aetna Medicare Advantage |
$52.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.69
|
| Rate for Payer: Cigna Commercial |
$55.88
|
| Rate for Payer: Cigna Medicare Advantage |
$16.26
|
| Rate for Payer: Clover Medicare Advantage |
$15.45
|
| Rate for Payer: EmblemHealth Commercial |
$48.78
|
| Rate for Payer: Humana Medicare Advantage |
$16.75
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.52
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.01
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.96
|
|
|
HEAVY METALS PROFILE BLOOD I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
3038536A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$51.60
|
| Rate for Payer: Aetna Medicare Advantage |
$61.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.48
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.97
|
| Rate for Payer: Clover Medicare Advantage |
$18.02
|
| Rate for Payer: EmblemHealth Commercial |
$56.91
|
| Rate for Payer: Humana Medicare Advantage |
$19.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.97
|
| 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 |
$15.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEAVY METALS PROFILE BLOOD I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
3038536A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEAVY METALS PROFILE BLOOD II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
3038536C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEAVY METALS PROFILE BLOOD II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
3038536C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$44.23
|
| Rate for Payer: Aetna Medicare Advantage |
$52.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.69
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.26
|
| Rate for Payer: Clover Medicare Advantage |
$15.45
|
| Rate for Payer: EmblemHealth Commercial |
$48.78
|
| Rate for Payer: Humana Medicare Advantage |
$16.75
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.26
|
| 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 |
$13.01
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEAVY METALS PROFILE BLOOD II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
3038536B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$32.94
|
| Rate for Payer: Aetna Medicare Advantage |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.71
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.11
|
| Rate for Payer: Clover Medicare Advantage |
$11.50
|
| Rate for Payer: EmblemHealth Commercial |
$36.33
|
| Rate for Payer: Humana Medicare Advantage |
$12.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.11
|
| 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 |
$9.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEAVY METALS PROFILE BLOOD II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
3038536B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEAVY METALS,URINE
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
HCPCS 83015
|
| Hospital Charge Code |
38472389
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.00
|
|
|
HEAVY METALS,URINE
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
HCPCS 83015
|
| Hospital Charge Code |
38472389
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$56.96
|
| Rate for Payer: Aetna Medicare Advantage |
$67.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.94
|
| 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 |
$75.59
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.94
|
| Rate for Payer: Clover Medicare Advantage |
$19.89
|
| Rate for Payer: EmblemHealth Commercial |
$62.82
|
| Rate for Payer: Humana Medicare Advantage |
$21.57
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$138.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.19
|
|
|
HECTOROL 0.5MCG TAB
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
60635553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Medicare Advantage |
$3.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.31
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.90
|
| Rate for Payer: Oxford Commercial |
$2.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.34
|
|
|
HECTOROL 0.5MCG TAB
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
60635553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
|
|
HEDRON IA SPACER 26X34, 13MM,
|
Facility
|
IP
|
$30,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,260.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,600.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,500.00
|
|
