|
PM-UR OV NP EXPANDED FOCUSED
|
Facility
|
OP
|
$319.65
|
|
|
Service Code
|
HCPCS 99201
|
| Hospital Charge Code |
75190170
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$159.82 |
| Rate for Payer: Aetna Commercial |
$121.47
|
| Rate for Payer: Aetna Medicare Advantage |
$95.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$81.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$81.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$81.51
|
| Rate for Payer: Cigna Commercial |
$159.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$95.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.47
|
|
|
PM-UR OV NP EXPANDED FOCUSED
|
Facility
|
IP
|
$319.65
|
|
|
Service Code
|
HCPCS 99201
|
| Hospital Charge Code |
75190170
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.95 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.95
|
|
|
PNA FISH I
|
Facility
|
IP
|
$234.17
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
39880001A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$35.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.13
|
|
|
PNA FISH I
|
Facility
|
OP
|
$234.17
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
39880001A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare Advantage |
$64.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$42.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.37
|
| Rate for Payer: Cigna Commercial |
$117.08
|
| Rate for Payer: Cigna Medicare Advantage |
$20.05
|
| Rate for Payer: Clover Medicare Advantage |
$19.05
|
| Rate for Payer: EmblemHealth Commercial |
$60.15
|
| Rate for Payer: Humana Medicare Advantage |
$20.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.25
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.21
|
|
|
PNA FISH II
|
Facility
|
OP
|
$234.17
|
|
|
Service Code
|
HCPCS 8714959
|
| Hospital Charge Code |
39880001B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$88.98
|
| Rate for Payer: Aetna Medicare Advantage |
$70.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.71
|
| Rate for Payer: Cigna Commercial |
$117.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.25
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.21
|
|
|
PNA FISH II
|
Facility
|
IP
|
$234.17
|
|
|
Service Code
|
HCPCS 8714959
|
| Hospital Charge Code |
39880001B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$35.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.13
|
|
|
PNEUMGRAM
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 94772
|
| Hospital Charge Code |
83090015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$184.95 |
| Max. Negotiated Rate |
$184.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.95
|
|
|
PNEUMGRAM
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 94772
|
| Hospital Charge Code |
83090015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$1,205.83
|
| Rate for Payer: Aetna Medicare Advantage |
$1,436.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,600.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,600.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$443.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$232.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,600.25
|
| Rate for Payer: Cigna Commercial |
$888.63
|
| Rate for Payer: Cigna Medicare Advantage |
$443.32
|
| Rate for Payer: Clover Medicare Advantage |
$421.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,329.96
|
| Rate for Payer: Humana Medicare Advantage |
$456.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$443.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$369.90
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.67
|
|
|
PNEUMO 1
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057A
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
PNEUMO 1
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057A
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
PNEUMO 12
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057G
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
PNEUMO 12
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057G
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
PNEUMO 14
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057H
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
PNEUMO 14
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057H
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
PNEUMO 19
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057I
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
PNEUMO 19
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057I
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
PNEUMO 23
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057J
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
PNEUMO 23
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057J
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
PNEUMO 26
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057D
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
PNEUMO 26
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057D
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
PNEUMO 3
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
PNEUMO 3
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
PNEUMO 4
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057C
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
PNEUMO 4
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057C
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
PNEUMO 51
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3035057K
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
