|
INHIBIN A
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
38477009
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna Medicare Advantage |
$50.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.28
|
| Rate for Payer: Cigna Commercial |
$55.00
|
| Rate for Payer: Cigna Medicare Advantage |
$15.59
|
| Rate for Payer: Clover Medicare Advantage |
$14.81
|
| Rate for Payer: EmblemHealth Commercial |
$46.77
|
| Rate for Payer: Humana Medicare Advantage |
$16.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.47
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.92
|
|
|
INHIBIN A
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
39900216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna Medicare Advantage |
$50.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.28
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$15.59
|
| Rate for Payer: Clover Medicare Advantage |
$14.81
|
| Rate for Payer: EmblemHealth Commercial |
$46.77
|
| Rate for Payer: Humana Medicare Advantage |
$16.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.59
|
| 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 |
$12.47
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
INHIBIN A
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
38479406
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
|
|
INHIBIN A
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
38479406
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna Medicare Advantage |
$50.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.28
|
| Rate for Payer: Cigna Commercial |
$55.00
|
| Rate for Payer: Cigna Medicare Advantage |
$15.59
|
| Rate for Payer: Clover Medicare Advantage |
$14.81
|
| Rate for Payer: EmblemHealth Commercial |
$46.77
|
| Rate for Payer: Humana Medicare Advantage |
$16.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.47
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.92
|
|
|
INHIBIN A
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
39900216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
INHIBIN A, ULTRASENSITIVE
|
Facility
|
IP
|
$110.35
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
3038113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.55
|
|
|
INHIBIN A, ULTRASENSITIVE
|
Facility
|
OP
|
$110.35
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
3038113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna Medicare Advantage |
$50.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.28
|
| Rate for Payer: Cigna Commercial |
$55.17
|
| Rate for Payer: Cigna Medicare Advantage |
$15.59
|
| Rate for Payer: Clover Medicare Advantage |
$14.81
|
| Rate for Payer: EmblemHealth Commercial |
$46.77
|
| Rate for Payer: Humana Medicare Advantage |
$16.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.47
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.92
|
|
|
INHIBIN B
|
Facility
|
OP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3038112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$126.72
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.03
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.72
|
|
|
INHIBIN B
|
Facility
|
IP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3038112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.02 |
| Max. Negotiated Rate |
$38.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
|
|
INHIBIN B
|
Facility
|
IP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3038149
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.02 |
| Max. Negotiated Rate |
$38.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
|
|
INHIBIN B
|
Facility
|
OP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3038149
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$126.72
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.03
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.72
|
|
|
INHIBIN B
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
39900439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
INHIBIN B
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
39900439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$38.41
|
| Rate for Payer: Aetna Medicare Advantage |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$50.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$50.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$50.97
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.12
|
| Rate for Payer: Clover Medicare Advantage |
$13.41
|
| Rate for Payer: EmblemHealth Commercial |
$42.36
|
| Rate for Payer: Humana Medicare Advantage |
$14.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.12
|
| 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 |
$11.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
INITIAL ASSESSMENT BY SW
|
Facility
|
IP
|
$449.95
|
|
|
Service Code
|
HCPCS 90801
|
| Hospital Charge Code |
9310085
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$67.49 |
| Max. Negotiated Rate |
$67.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.49
|
|
|
INITIAL ASSESSMENT BY SW
|
Facility
|
OP
|
$449.95
|
|
|
Service Code
|
HCPCS 90801
|
| Hospital Charge Code |
9310085
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$3,081.00 |
| Rate for Payer: Aetna Commercial |
$170.98
|
| Rate for Payer: Aetna Medicare Advantage |
$134.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.74
|
| Rate for Payer: Cigna Commercial |
$224.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.99
|
| Rate for Payer: Oxford Commercial |
$1,757.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,081.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.92
|
|
|
INITIAL DX ASSESSMENT*****
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 90801
|
| Hospital Charge Code |
9310012
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
INITIAL DX ASSESSMENT*****
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 90801
|
| Hospital Charge Code |
9310012
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Medicare Advantage |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.20
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.36
|
|
|
INITIAL MEDICAL VISIT WHC****
|
Facility
|
IP
|
$49.50
|
|
|
Service Code
|
HCPCS 99203WF
|
| Hospital Charge Code |
9600011
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.42
|
|
|
INITIAL MEDICAL VISIT WHC****
|
Facility
|
OP
|
$49.50
|
|
|
Service Code
|
HCPCS 99203WF
|
| Hospital Charge Code |
9600011
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: Aetna Commercial |
$18.81
|
| Rate for Payer: Aetna Medicare Advantage |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.62
|
| Rate for Payer: Cigna Commercial |
$24.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.31
|
|
|
INITIAL PREVENTIVE PHY EXAM GE
|
Facility
|
IP
|
$500.45
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
87502820
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$75.07 |
| Max. Negotiated Rate |
$75.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.07
|
|
|
INITIAL PREVENTIVE PHY EXAM GE
|
Facility
|
OP
|
$500.45
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
87502820
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$570.95 |
| Rate for Payer: Aetna Commercial |
$430.22
|
| Rate for Payer: Aetna Medicare Advantage |
$512.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.95
|
| Rate for Payer: Cigna Commercial |
$317.04
|
| Rate for Payer: Cigna Medicare Advantage |
$158.17
|
| Rate for Payer: Clover Medicare Advantage |
$150.26
|
| Rate for Payer: EmblemHealth Commercial |
$474.51
|
| Rate for Payer: Humana Medicare Advantage |
$162.92
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$150.13
|
| Rate for Payer: Oxford Commercial |
$100.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.26
|
|
|
INJ/AIR/CONT INTO PERITONEAL
|
Facility
|
OP
|
$509.70
|
|
|
Service Code
|
HCPCS 49400
|
| Hospital Charge Code |
1600000353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$193.69
|
| Rate for Payer: Aetna Medicare Advantage |
$152.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$129.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$129.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$129.97
|
| Rate for Payer: Cigna Commercial |
$254.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.91
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.51
|
|
|
INJ/AIR/CONT INTO PERITONEAL
|
Facility
|
IP
|
$509.70
|
|
|
Service Code
|
HCPCS 49400
|
| Hospital Charge Code |
1600000353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$76.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.45
|
|
|
INJ ANESTH,PUDENDAL NERVE
|
Facility
|
OP
|
$7,956.80
|
|
|
Service Code
|
HCPCS 64430
|
| Hospital Charge Code |
16001032
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$191.76 |
| Max. Negotiated Rate |
$3,793.00 |
| Rate for Payer: Aetna Commercial |
$2,858.12
|
| Rate for Payer: Aetna Medicare Advantage |
$3,404.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,793.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,793.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,050.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,793.00
|
| Rate for Payer: Cigna Commercial |
$2,106.27
|
| Rate for Payer: Cigna Medicare Advantage |
$1,050.78
|
| Rate for Payer: Clover Medicare Advantage |
$998.24
|
| Rate for Payer: EmblemHealth Commercial |
$3,152.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,082.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,050.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,387.04
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,193.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$191.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,050.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,050.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$210.86
|
|
|
INJ ANESTH,PUDENDAL NERVE
|
Facility
|
IP
|
$7,956.80
|
|
|
Service Code
|
HCPCS 64430
|
| Hospital Charge Code |
16001032
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,193.52 |
| Max. Negotiated Rate |
$1,193.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,193.52
|
|
