|
MYOFLEX CREAM
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
NDC 45802035653
|
| Hospital Charge Code |
60635110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: Aetna Commercial |
$9.65
|
| Rate for Payer: Aetna Medicare Advantage |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.47
|
| Rate for Payer: Cigna Commercial |
$12.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.62
|
| Rate for Payer: Oxford Commercial |
$5.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.67
|
|
|
MYOGLOBIN QUANT, URINE
|
Facility
|
OP
|
$122.50
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
3003472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare Advantage |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.64
|
| Rate for Payer: Cigna Commercial |
$61.25
|
| Rate for Payer: Cigna Medicare Advantage |
$12.92
|
| Rate for Payer: Clover Medicare Advantage |
$12.27
|
| Rate for Payer: EmblemHealth Commercial |
$38.76
|
| Rate for Payer: Humana Medicare Advantage |
$13.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.75
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.25
|
|
|
MYOGLOBIN QUANT, URINE
|
Facility
|
IP
|
$122.50
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
3003472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.38
|
|
|
MYOGLOBIN (SERUM)
|
Facility
|
OP
|
$122.50
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
3030251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare Advantage |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.64
|
| Rate for Payer: Cigna Commercial |
$61.25
|
| Rate for Payer: Cigna Medicare Advantage |
$12.92
|
| Rate for Payer: Clover Medicare Advantage |
$12.27
|
| Rate for Payer: EmblemHealth Commercial |
$38.76
|
| Rate for Payer: Humana Medicare Advantage |
$13.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.75
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.25
|
|
|
MYOGLOBIN (SERUM)
|
Facility
|
IP
|
$122.50
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
3030251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.38
|
|
|
MYOGLOBIN SERUM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
39900342
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
MYOGLOBIN SERUM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
39900342
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare Advantage |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.64
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.92
|
| Rate for Payer: Clover Medicare Advantage |
$12.27
|
| Rate for Payer: EmblemHealth Commercial |
$38.76
|
| Rate for Payer: Humana Medicare Advantage |
$13.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.92
|
| 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 |
$10.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
MYOGLOBIN,SERUM
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
38472516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$244.50 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare Advantage |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.64
|
| Rate for Payer: Cigna Commercial |
$244.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.92
|
| Rate for Payer: Clover Medicare Advantage |
$12.27
|
| Rate for Payer: EmblemHealth Commercial |
$38.76
|
| Rate for Payer: Humana Medicare Advantage |
$13.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.96
|
|
|
MYOGLOBIN,SERUM
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
38472516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.35 |
| Max. Negotiated Rate |
$73.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.35
|
|
|
MYOGLOBIN URINE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
39900110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
MYOGLOBIN URINE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
39900110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare Advantage |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.64
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.92
|
| Rate for Payer: Clover Medicare Advantage |
$12.27
|
| Rate for Payer: EmblemHealth Commercial |
$38.76
|
| Rate for Payer: Humana Medicare Advantage |
$13.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.92
|
| 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 |
$10.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
MYOGLOBIN, URINE
|
Facility
|
OP
|
$122.50
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
3006280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare Advantage |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.64
|
| Rate for Payer: Cigna Commercial |
$61.25
|
| Rate for Payer: Cigna Medicare Advantage |
$12.92
|
| Rate for Payer: Clover Medicare Advantage |
$12.27
|
| Rate for Payer: EmblemHealth Commercial |
$38.76
|
| Rate for Payer: Humana Medicare Advantage |
$13.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.75
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.25
|
|
|
MYOGLOBIN, URINE
|
Facility
|
IP
|
$122.50
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
3006280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.38
|
|
|
MYOGLOBIN,URINE
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
38472517
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.65 |
| Max. Negotiated Rate |
$61.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.65
|
|
|
MYOGLOBIN,URINE
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
38472517
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$205.50 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare Advantage |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.64
|
| Rate for Payer: Cigna Commercial |
$205.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.92
|
| Rate for Payer: Clover Medicare Advantage |
$12.27
|
| Rate for Payer: EmblemHealth Commercial |
$38.76
|
| Rate for Payer: Humana Medicare Advantage |
$13.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$123.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.89
|
|
|
MYOMECTMY ABDOM CMPX 5+MYOMAS
|
Facility
|
OP
|
$18,219.48
|
|
|
Service Code
|
HCPCS 58146
|
| Hospital Charge Code |
160000208
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$439.09 |
| Max. Negotiated Rate |
$10,232.00 |
| Rate for Payer: Aetna Commercial |
$6,923.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5,465.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,645.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,645.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,645.97
|
| Rate for Payer: Cigna Commercial |
$9,109.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,465.84
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,732.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$439.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$482.82
|
|
|
MYOMECTMY ABDOM CMPX 5+MYOMAS
|
Facility
|
IP
|
$18,219.48
|
|
|
Service Code
|
HCPCS 58146
|
| Hospital Charge Code |
160000208
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,732.92 |
| Max. Negotiated Rate |
$2,732.92 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,732.92
|
|
|
MYOMECTMY ABDOM METHOD 1-4MYMS
|
Facility
|
OP
|
$14,539.99
|
|
|
Service Code
|
HCPCS 58140
|
| Hospital Charge Code |
16001004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$350.41 |
| Max. Negotiated Rate |
$10,232.00 |
| Rate for Payer: Aetna Commercial |
$5,525.20
|
| Rate for Payer: Aetna Medicare Advantage |
$4,362.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,707.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,707.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,707.70
|
| Rate for Payer: Cigna Commercial |
$7,269.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,362.00
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,181.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$350.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$385.31
|
|
|
MYOMECTMY ABDOM METHOD 1-4MYMS
|
Facility
|
IP
|
$14,539.99
|
|
|
Service Code
|
HCPCS 58140
|
| Hospital Charge Code |
16001004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,181.00 |
| Max. Negotiated Rate |
$2,181.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,181.00
|
|
|
MYOMECTMY ABDOM METHOD 1-4MYMS
|
Facility
|
OP
|
$14,539.99
|
|
|
Service Code
|
HCPCS 58140
|
| Hospital Charge Code |
14539.99
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$350.41 |
| Max. Negotiated Rate |
$10,232.00 |
| Rate for Payer: Aetna Commercial |
$5,525.20
|
| Rate for Payer: Aetna Medicare Advantage |
$4,362.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,707.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,707.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,707.70
|
| Rate for Payer: Cigna Commercial |
$7,269.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,362.00
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,181.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$350.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$385.31
|
|
|
MYOMECTMY ABDOM METHOD 1-4MYMS
|
Facility
|
IP
|
$14,539.99
|
|
|
Service Code
|
HCPCS 58140
|
| Hospital Charge Code |
14539.99
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,181.00 |
| Max. Negotiated Rate |
$2,181.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,181.00
|
|
|
MYOMECTOMY,EXC FIBROIDS-UTER
|
Facility
|
OP
|
$9,489.90
|
|
|
Service Code
|
HCPCS 58140
|
| Hospital Charge Code |
73190009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.71 |
| Max. Negotiated Rate |
$10,232.00 |
| Rate for Payer: Aetna Commercial |
$3,606.16
|
| Rate for Payer: Aetna Medicare Advantage |
$2,846.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,419.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,419.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,419.92
|
| Rate for Payer: Cigna Commercial |
$4,744.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,846.97
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,423.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$228.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$251.48
|
|
|
MYOMECTOMY,EXC FIBROIDS-UTER
|
Facility
|
IP
|
$9,489.90
|
|
|
Service Code
|
HCPCS 58140
|
| Hospital Charge Code |
73190009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,423.48 |
| Max. Negotiated Rate |
$1,423.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,423.48
|
|
|
MYOPLASMA PNEUMONIAE ANTIBODIE
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
38476138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.80
|
|
|
MYOPLASMA PNEUMONIAE ANTIBODIE
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
38476138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna Commercial |
$36.01
|
| Rate for Payer: Aetna Medicare Advantage |
$42.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.79
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.24
|
| Rate for Payer: Clover Medicare Advantage |
$12.58
|
| Rate for Payer: EmblemHealth Commercial |
$39.72
|
| Rate for Payer: Humana Medicare Advantage |
$13.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.21
|
|
