|
IGG INDEX + SYNTHESIS RATE IV
|
Facility
|
OP
|
$81.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3037055D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.57
|
| Rate for Payer: Cigna Commercial |
$40.62
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.38
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
IGG INDEX + SYNTHESIS RATE IV
|
Facility
|
IP
|
$81.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3037055D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$12.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.19
|
|
|
IGG SUBCLASSES, EACH
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
38472028
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Medicare Advantage |
$25.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$131.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.95
|
| Rate for Payer: Cigna Commercial |
$287.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.02
|
| Rate for Payer: Clover Medicare Advantage |
$7.62
|
| Rate for Payer: EmblemHealth Commercial |
$24.06
|
| Rate for Payer: Humana Medicare Advantage |
$8.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$172.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.21
|
|
|
IGG SUBCLASSES, EACH
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
38472028
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.10
|
|
|
IGG SUBCLASSES PANEL I
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
39990068A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.57
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| 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 |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
IGG SUBCLASSES PANEL I
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
39990068A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
IGG SUBCLASSES PANEL II
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
39990068B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Medicare Advantage |
$25.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$131.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.95
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$8.02
|
| Rate for Payer: Clover Medicare Advantage |
$7.62
|
| Rate for Payer: EmblemHealth Commercial |
$24.06
|
| Rate for Payer: Humana Medicare Advantage |
$8.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.02
|
| 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 |
$6.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
IGG SUBCLASSES PANEL II
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
39990068B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
IGG SUBCLASSES PANEL III
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
39990068C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
IGG SUBCLASSES PANEL III
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
39990068C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Medicare Advantage |
$25.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$131.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.95
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$8.02
|
| Rate for Payer: Clover Medicare Advantage |
$7.62
|
| Rate for Payer: EmblemHealth Commercial |
$24.06
|
| Rate for Payer: Humana Medicare Advantage |
$8.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.02
|
| 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 |
$6.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
IGG SUBCLASSES PANEL IV
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
39990068D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Medicare Advantage |
$25.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$131.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.95
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$8.02
|
| Rate for Payer: Clover Medicare Advantage |
$7.62
|
| Rate for Payer: EmblemHealth Commercial |
$24.06
|
| Rate for Payer: Humana Medicare Advantage |
$8.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.02
|
| 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 |
$6.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
IGG SUBCLASSES PANEL IV
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
39990068D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
IGG SUBCLASSES PANEL V
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
39990068E
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
IGG SUBCLASSES PANEL V
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
39990068E
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$21.81
|
| Rate for Payer: Aetna Medicare Advantage |
$25.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$131.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.95
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$8.02
|
| Rate for Payer: Clover Medicare Advantage |
$7.62
|
| Rate for Payer: EmblemHealth Commercial |
$24.06
|
| Rate for Payer: Humana Medicare Advantage |
$8.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.02
|
| 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 |
$6.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
IGG SUBCLASSES PROFILE
|
Facility
|
OP
|
$81.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3006665A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.57
|
| Rate for Payer: Cigna Commercial |
$40.62
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.38
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
IGG SUBCLASSES PROFILE
|
Facility
|
IP
|
$81.25
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3006665A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$12.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.19
|
|
|
IGIV HUMAN FOR INTRAVENEOS USE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 90283
|
| Hospital Charge Code |
3408005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$129.71 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Medicare Advantage |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$129.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.90
|
| Rate for Payer: Cigna Commercial |
$90.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.77
|
|
|
IGIV HUMAN FOR INTRAVENEOS USE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 90283
|
| Hospital Charge Code |
3408005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$43.56 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
|
|
IGK REARRANGEABN CLONAL POP
|
Facility
|
IP
|
$760.50
|
|
|
Service Code
|
HCPCS 81264
|
| Hospital Charge Code |
401081264
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.08 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.08
|
|
|
IGK REARRANGEABN CLONAL POP
|
Facility
|
OP
|
$760.50
|
|
|
Service Code
|
HCPCS 81264
|
| Hospital Charge Code |
401081264
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$623.50 |
| Rate for Payer: Aetna Commercial |
$469.83
|
| Rate for Payer: Aetna Medicare Advantage |
$559.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$623.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$623.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$172.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$623.50
|
| Rate for Payer: Cigna Commercial |
$380.25
|
| Rate for Payer: Cigna Medicare Advantage |
$172.73
|
| Rate for Payer: Clover Medicare Advantage |
$164.09
|
| Rate for Payer: EmblemHealth Commercial |
$518.19
|
| Rate for Payer: Humana Medicare Advantage |
$177.91
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$172.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$228.15
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$138.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$172.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$172.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.15
|
|
|
IgM
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38472413
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$126.50 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.57
|
| Rate for Payer: Cigna Commercial |
$126.50
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.70
|
|
|
IgM
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38472413
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
|
|
IGM
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38479449
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
|
|
IGM
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38479449
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$126.50 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.57
|
| Rate for Payer: Cigna Commercial |
$126.50
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.70
|
|
|
IGM
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38479417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.95
|
|
