|
ANTI-THROMBIN III,ANTIGEN
|
Facility
|
OP
|
$74.30
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
39900164
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$29.40
|
| Rate for Payer: Aetna Medicare Advantage |
$35.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.02
|
| Rate for Payer: Cigna Commercial |
$37.15
|
| Rate for Payer: Cigna Medicare Advantage |
$10.81
|
| Rate for Payer: Clover Medicare Advantage |
$10.27
|
| Rate for Payer: EmblemHealth Commercial |
$32.43
|
| Rate for Payer: Humana Medicare Advantage |
$11.13
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.29
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.97
|
|
|
ANTI THROMBIN III, ENZYMATIC
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
3007135A
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.40
|
|
|
ANTI THROMBIN III, ENZYMATIC
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
3007135A
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna Commercial |
$32.23
|
| Rate for Payer: Aetna Medicare Advantage |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.77
|
| Rate for Payer: Cigna Commercial |
$128.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.85
|
| Rate for Payer: Clover Medicare Advantage |
$11.26
|
| Rate for Payer: EmblemHealth Commercial |
$35.55
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.78
|
|
|
ANTI THROMBIN III FUNCTIONAL
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
3007136
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna Commercial |
$32.23
|
| Rate for Payer: Aetna Medicare Advantage |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.77
|
| Rate for Payer: Cigna Commercial |
$128.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.85
|
| Rate for Payer: Clover Medicare Advantage |
$11.26
|
| Rate for Payer: EmblemHealth Commercial |
$35.55
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.78
|
|
|
ANTI THROMBIN III FUNCTIONAL
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
3007136
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.40
|
|
|
ANTI THROMBIN III PANEL
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
3007135
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna Commercial |
$32.23
|
| Rate for Payer: Aetna Medicare Advantage |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.77
|
| Rate for Payer: Cigna Commercial |
$128.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.85
|
| Rate for Payer: Clover Medicare Advantage |
$11.26
|
| Rate for Payer: EmblemHealth Commercial |
$35.55
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.78
|
|
|
ANTI THROMBIN III PANEL
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
3007135
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.40
|
|
|
ANTI-THYROGLOBULIN AB
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
38476010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$261.50 |
| Rate for Payer: Aetna Commercial |
$43.28
|
| Rate for Payer: Aetna Medicare Advantage |
$51.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.43
|
| Rate for Payer: Cigna Commercial |
$261.50
|
| Rate for Payer: Cigna Medicare Advantage |
$15.91
|
| Rate for Payer: Clover Medicare Advantage |
$15.11
|
| Rate for Payer: EmblemHealth Commercial |
$47.73
|
| Rate for Payer: Humana Medicare Advantage |
$16.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.86
|
|
|
ANTI-THYROGLOBULIN AB
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
38476010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.45 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
|
|
ANTI-THYROGLOBULIN AND MICROSO
|
Facility
|
IP
|
$823.20
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
38476069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$123.48 |
| Max. Negotiated Rate |
$123.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.48
|
|
|
ANTI-THYROGLOBULIN AND MICROSO
|
Facility
|
OP
|
$823.20
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
38476069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$411.60 |
| Rate for Payer: Aetna Commercial |
$39.58
|
| Rate for Payer: Aetna Medicare Advantage |
$47.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.55
|
| 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 |
$52.52
|
| Rate for Payer: Cigna Commercial |
$411.60
|
| Rate for Payer: Cigna Medicare Advantage |
$14.55
|
| Rate for Payer: Clover Medicare Advantage |
$13.82
|
| Rate for Payer: EmblemHealth Commercial |
$43.65
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.96
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.81
|
|
|
***ANTI-THYROID AB***
|
Facility
|
OP
|
$195.85
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
3031119
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$43.28
|
| Rate for Payer: Aetna Medicare Advantage |
$51.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.43
|
| Rate for Payer: Cigna Commercial |
$97.92
|
| Rate for Payer: Cigna Medicare Advantage |
$15.91
|
| Rate for Payer: Clover Medicare Advantage |
$15.11
|
| Rate for Payer: EmblemHealth Commercial |
$47.73
|
| Rate for Payer: Humana Medicare Advantage |
$16.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.76
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.19
|
|
|
***ANTI-THYROID AB***
|
Facility
|
IP
|
$195.85
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
3031119
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.38
|
|
|
ANTI-THYROID MICROSOMAL AB
|
Facility
|
OP
|
$823.20
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
38476011
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$411.60 |
| Rate for Payer: Aetna Commercial |
$39.58
|
| Rate for Payer: Aetna Medicare Advantage |
$47.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.55
|
| 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 |
$52.52
|
| Rate for Payer: Cigna Commercial |
$411.60
|
| Rate for Payer: Cigna Medicare Advantage |
$14.55
|
| Rate for Payer: Clover Medicare Advantage |
$13.82
|
| Rate for Payer: EmblemHealth Commercial |
$43.65
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.96
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.81
|
|
|
ANTI-THYROID MICROSOMAL AB
|
Facility
|
IP
|
$823.20
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
38476011
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$123.48 |
| Max. Negotiated Rate |
$123.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.48
|
|
|
ANTIVENIN CROTAL INJ 10ML
|
Facility
|
OP
|
$1,116.80
|
|
| Hospital Charge Code |
6000459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$558.40 |
| Rate for Payer: Aetna Commercial |
$424.38
|
| Rate for Payer: Aetna Medicare Advantage |
$335.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$284.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$284.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$284.78
|
| Rate for Payer: Cigna Commercial |
$558.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$335.04
|
| Rate for Payer: Oxford Commercial |
$223.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$167.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$223.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.60
|
|
|
ANTIVENIN CROTAL INJ 10ML
|
Facility
|
IP
|
$1,116.80
|
|
| Hospital Charge Code |
6000459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$167.52 |
| Max. Negotiated Rate |
$167.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$167.52
|
|
|
ANTI YO ANTIBODY
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
38476233
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: Aetna Medicare Advantage |
$58.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.72
|
| Rate for Payer: Cigna Commercial |
$164.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.93
|
| Rate for Payer: Clover Medicare Advantage |
$17.03
|
| Rate for Payer: EmblemHealth Commercial |
$53.79
|
| Rate for Payer: Humana Medicare Advantage |
$18.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.72
|
|
|
ANTI YO ANTIBODY
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
38476233
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$49.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
|
|
ANT LUM CAGE 10X25X33MMX10D
|
Facility
|
OP
|
$42,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.20 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$15,960.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,710.00
|
| Rate for Payer: Cigna Commercial |
$21,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,164.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,240.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,012.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,113.00
|
|
|
ANT LUM CAGE 10X25X33MMX10D
|
Facility
|
IP
|
$42,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,300.00 |
| Max. Negotiated Rate |
$10,164.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,164.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,240.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,300.00
|
|
|
ANT LUM CAGE 12X28X36MM 10DEG
|
Facility
|
IP
|
$42,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,300.00 |
| Max. Negotiated Rate |
$10,164.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,164.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,240.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,300.00
|
|
|
ANT LUM CAGE 12X28X36MM 10DEG
|
Facility
|
OP
|
$42,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.20 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$15,960.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,710.00
|
| Rate for Payer: Cigna Commercial |
$21,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,164.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,240.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,012.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,113.00
|
|
|
ANT LUM CAGE 12X28X36MM 15DEG
|
Facility
|
OP
|
$42,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.20 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$15,960.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,710.00
|
| Rate for Payer: Cigna Commercial |
$21,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,164.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,240.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,012.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,113.00
|
|
|
ANT LUM CAGE 12X28X36MM 15DEG
|
Facility
|
IP
|
$42,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,300.00 |
| Max. Negotiated Rate |
$10,164.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,164.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,240.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,300.00
|
|
