|
HEMOGLOBIN HGB
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
3031697
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$6.45
|
| Rate for Payer: Aetna Medicare Advantage |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.55
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$2.37
|
| Rate for Payer: Clover Medicare Advantage |
$2.25
|
| Rate for Payer: EmblemHealth Commercial |
$7.11
|
| Rate for Payer: Humana Medicare Advantage |
$2.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.37
|
| 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 |
$1.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
HEMOGLOBIN (HGB) A1C
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
3035006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: Aetna Medicare Advantage |
$31.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35.05
|
| Rate for Payer: Cigna Commercial |
$24.00
|
| Rate for Payer: Cigna Medicare Advantage |
$9.71
|
| Rate for Payer: Clover Medicare Advantage |
$9.22
|
| Rate for Payer: EmblemHealth Commercial |
$29.13
|
| Rate for Payer: Humana Medicare Advantage |
$10.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.71
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.27
|
|
|
HEMOGLOBIN (HGB) A1C
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
3035006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.20
|
|
|
HEMOGLOBINOPATHY EVALUATION I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85041
|
| Hospital Charge Code |
39990070D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEMOGLOBINOPATHY EVALUATION I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85041
|
| Hospital Charge Code |
39990070D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$8.21
|
| Rate for Payer: Aetna Medicare Advantage |
$9.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.90
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.02
|
| Rate for Payer: Clover Medicare Advantage |
$2.87
|
| Rate for Payer: EmblemHealth Commercial |
$9.06
|
| Rate for Payer: Humana Medicare Advantage |
$3.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.02
|
| 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 |
$2.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEMOGLOBINOPATHY EVALUATION I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
39990070A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$49.12
|
| Rate for Payer: Aetna Medicare Advantage |
$58.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.19
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.06
|
| Rate for Payer: Clover Medicare Advantage |
$17.16
|
| Rate for Payer: EmblemHealth Commercial |
$54.18
|
| Rate for Payer: Humana Medicare Advantage |
$18.60
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.06
|
| 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 |
$14.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEMOGLOBINOPATHY EVALUATION I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
39990070C
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$6.45
|
| Rate for Payer: Aetna Medicare Advantage |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.55
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$2.37
|
| Rate for Payer: Clover Medicare Advantage |
$2.25
|
| Rate for Payer: EmblemHealth Commercial |
$7.11
|
| Rate for Payer: Humana Medicare Advantage |
$2.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.37
|
| 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 |
$1.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEMOGLOBINOPATHY EVALUATION I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
39990070B
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEMOGLOBINOPATHY EVALUATION I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
39990070A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEMOGLOBINOPATHY EVALUATION I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
39990070B
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$6.45
|
| Rate for Payer: Aetna Medicare Advantage |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.55
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$2.37
|
| Rate for Payer: Clover Medicare Advantage |
$2.25
|
| Rate for Payer: EmblemHealth Commercial |
$7.11
|
| Rate for Payer: Humana Medicare Advantage |
$2.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.37
|
| 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 |
$1.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEMOGLOBINOPATHY EVALUATION I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
39990070C
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEMOGLOBIN (PLASMA)
|
Facility
|
OP
|
$67.25
|
|
|
Service Code
|
HCPCS 83051
|
| Hospital Charge Code |
3030277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$19.88
|
| Rate for Payer: Aetna Medicare Advantage |
$23.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.39
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: Cigna Medicare Advantage |
$7.31
|
| Rate for Payer: Clover Medicare Advantage |
$6.94
|
| Rate for Payer: EmblemHealth Commercial |
$21.93
|
| Rate for Payer: Humana Medicare Advantage |
$7.53
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.18
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.85
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|
|
HEMOGLOBIN (PLASMA)
|
Facility
|
IP
|
$67.25
|
|
|
Service Code
|
HCPCS 83051
|
| Hospital Charge Code |
3030277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$10.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
HEMOGLOBIN,URINARY FREE
|
Facility
|
OP
|
$268.50
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3031699
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Aetna Commercial |
$6.12
|
| Rate for Payer: Aetna Medicare Advantage |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.12
|
| Rate for Payer: Cigna Commercial |
$134.25
|
| Rate for Payer: Cigna Medicare Advantage |
$2.25
|
| Rate for Payer: Clover Medicare Advantage |
$2.14
|
| Rate for Payer: EmblemHealth Commercial |
$6.75
|
| Rate for Payer: Humana Medicare Advantage |
$2.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.55
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.12
|
|
|
HEMOGLOBIN,URINARY FREE
|
Facility
|
IP
|
$268.50
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3031699
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.27
|
|
|
HEMOGLOBIN URINE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83069
|
| Hospital Charge Code |
38477022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEMOGLOBIN URINE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83069
|
| Hospital Charge Code |
38477022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$10.74
|
| Rate for Payer: Aetna Medicare Advantage |
$12.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.26
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.95
|
| Rate for Payer: Clover Medicare Advantage |
$3.75
|
| Rate for Payer: EmblemHealth Commercial |
$11.85
|
| Rate for Payer: Humana Medicare Advantage |
$4.07
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.95
|
| 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 |
$3.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEMOGLOBIN WHC****
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
HCPCS Q0116
|
| Hospital Charge Code |
9600030
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare Advantage |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.56
|
| Rate for Payer: Cigna Commercial |
$1.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.66
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.06
|
|
|
HEMOGLOBIN WHC****
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
HCPCS Q0116
|
| Hospital Charge Code |
9600030
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.33
|
|
|
HEMOPAD (8CM-10CM)/EACH
|
Facility
|
IP
|
$757.00
|
|
| Hospital Charge Code |
60633080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.55 |
| Max. Negotiated Rate |
$113.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.55
|
|
|
HEMOPAD (8CM-10CM)/EACH
|
Facility
|
OP
|
$757.00
|
|
| Hospital Charge Code |
60633080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$378.50 |
| Rate for Payer: Aetna Commercial |
$287.66
|
| Rate for Payer: Aetna Medicare Advantage |
$227.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$193.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$193.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$193.03
|
| Rate for Payer: Cigna Commercial |
$378.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$227.10
|
| Rate for Payer: Oxford Commercial |
$151.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$151.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.06
|
|
|
HEMOPLOBIN A2 QN
|
Facility
|
OP
|
$127.84
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
38478096
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$49.12
|
| Rate for Payer: Aetna Medicare Advantage |
$58.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.19
|
| Rate for Payer: Cigna Commercial |
$63.92
|
| Rate for Payer: Cigna Medicare Advantage |
$18.06
|
| Rate for Payer: Clover Medicare Advantage |
$17.16
|
| Rate for Payer: EmblemHealth Commercial |
$54.18
|
| Rate for Payer: Humana Medicare Advantage |
$18.60
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.35
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
|
HEMOPLOBIN A2 QN
|
Facility
|
IP
|
$127.84
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
38478096
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$19.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.18
|
|
|
HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION
|
Facility
|
IP
|
$12,301.07
|
|
|
Service Code
|
APR-DRG 8103
|
| Min. Negotiated Rate |
$12,059.87 |
| Max. Negotiated Rate |
$12,301.07 |
| Rate for Payer: UnitedHealthcare Community & State |
$12,059.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$12,301.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12,059.87
|
|
|
HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION
|
Facility
|
IP
|
$7,823.64
|
|
|
Service Code
|
APR-DRG 8102
|
| Min. Negotiated Rate |
$7,670.24 |
| Max. Negotiated Rate |
$7,823.64 |
| Rate for Payer: UnitedHealthcare Community & State |
$7,670.24
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$7,823.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7,670.24
|
|
