|
HYPNOTHERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4509523
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4517523
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4509523
|
|
Hospital Revenue Code
|
914
|
| 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 |
$98.02
|
| 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: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4527523
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4546523
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4518518
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4535523
|
|
Hospital Revenue Code
|
914
|
| 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 |
$98.02
|
| 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: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4535523
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4504523
|
|
Hospital Revenue Code
|
914
|
| 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 |
$98.02
|
| 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: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4515523
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4511523
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4832523
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4832523
|
|
Hospital Revenue Code
|
914
|
| 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 |
$98.02
|
| 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: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4511523
|
|
Hospital Revenue Code
|
914
|
| 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 |
$98.02
|
| 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: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4517523
|
|
Hospital Revenue Code
|
914
|
| 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 |
$98.02
|
| 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: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4518518
|
|
Hospital Revenue Code
|
914
|
| 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 |
$98.02
|
| 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: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4518617
|
|
Hospital Revenue Code
|
914
|
| 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 |
$98.02
|
| 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: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
HYPNOTHERAPY CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90880
|
| Hospital Charge Code |
4515523
|
|
Hospital Revenue Code
|
914
|
| 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 |
$98.02
|
| 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: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
HYPOGLYCEMIC PANEL SERUM/PLSMA
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
401083789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
HYPOGLYCEMIC PANEL SERUM/PLSMA
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
401083789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$65.58
|
| Rate for Payer: Aetna Medicare Advantage |
$78.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.11
|
| 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 |
$87.03
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.11
|
| Rate for Payer: Clover Medicare Advantage |
$22.90
|
| Rate for Payer: EmblemHealth Commercial |
$72.33
|
| Rate for Payer: Humana Medicare Advantage |
$24.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$150.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.25
|
|
|
HYPOTEARS 1% OPHTH/30ML
|
Facility
|
IP
|
$58.69
|
|
|
Service Code
|
NDC 536197072
|
| Hospital Charge Code |
60633142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.80
|
|
|
HYPOTEARS 1% OPHTH/30ML
|
Facility
|
OP
|
$58.69
|
|
|
Service Code
|
NDC 536197072
|
| Hospital Charge Code |
60633142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$29.34 |
| Rate for Payer: Aetna Commercial |
$22.30
|
| Rate for Payer: Aetna Medicare Advantage |
$17.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.97
|
| Rate for Payer: Cigna Commercial |
$29.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.61
|
| Rate for Payer: Oxford Commercial |
$11.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.74
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.56
|
|
|
HYPOTHERMIA MACHINE
|
Facility
|
OP
|
$133.65
|
|
| Hospital Charge Code |
2708000879
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$66.83 |
| Rate for Payer: Aetna Commercial |
$50.79
|
| Rate for Payer: Aetna Medicare Advantage |
$40.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.08
|
| Rate for Payer: Cigna Commercial |
$66.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.09
|
| Rate for Payer: Oxford Commercial |
$26.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.54
|
|
|
HYPOTHERMIA MACHINE
|
Facility
|
IP
|
$133.65
|
|
| Hospital Charge Code |
2708000879
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.05
|
|
|
HYPOTHERMIA PER DAY****
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
8000879
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$19.76
|
| Rate for Payer: Aetna Medicare Advantage |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.26
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.60
|
| Rate for Payer: Oxford Commercial |
$10.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.38
|
|
