|
SENSORY NEUROPATHY ANTIBODY I
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
3990148A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$33.82
|
| Rate for Payer: Aetna Medicare Advantage |
$26.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.70
|
| Rate for Payer: Cigna Commercial |
$44.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.36
|
|
|
SENSORY NEUROPATHY ANTIBODY II
|
Facility
|
OP
|
$116.20
|
|
|
Service Code
|
HCPCS 84181
|
| Hospital Charge Code |
39990148C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.47
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.86
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.08
|
|
|
SENSORY NEUROPATHY ANTIBODY II
|
Facility
|
IP
|
$116.20
|
|
|
Service Code
|
HCPCS 84181
|
| Hospital Charge Code |
39990148C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.43
|
|
|
SENSORY NEUROPATHY ANTIBODY II
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
39990148B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$44.50
|
| 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 |
$26.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.35
|
| 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 |
$2.36
|
|
|
SENSORY NEUROPATHY ANTIBODY II
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
39990148B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$13.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.35
|
|
|
SENSORY NEUROPATHY ANTIBODY IV
|
Facility
|
OP
|
$82.85
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
39990148D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare Advantage |
$39.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.50
|
| Rate for Payer: Cigna Commercial |
$41.42
|
| Rate for Payer: Cigna Medicare Advantage |
$12.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.45
|
| Rate for Payer: EmblemHealth Commercial |
$36.15
|
| Rate for Payer: Humana Medicare Advantage |
$12.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.86
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.20
|
|
|
SENSORY NEUROPATHY ANTIBODY IV
|
Facility
|
IP
|
$82.85
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
39990148D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.43
|
|
|
SENSORY NEUROPATHY ANTIBODY V
|
Facility
|
OP
|
$82.85
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
39990148E
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare Advantage |
$39.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.50
|
| Rate for Payer: Cigna Commercial |
$41.42
|
| Rate for Payer: Cigna Medicare Advantage |
$12.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.45
|
| Rate for Payer: EmblemHealth Commercial |
$36.15
|
| Rate for Payer: Humana Medicare Advantage |
$12.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.86
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.20
|
|
|
SENSORY NEUROPATHY ANTIBODY V
|
Facility
|
IP
|
$82.85
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
39990148E
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.43
|
|
|
SENSORY NEUROPATHY ANTIBODY VI
|
Facility
|
IP
|
$82.85
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
39990148G
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.43
|
|
|
SENSORY NEUROPATHY ANTIBODY VI
|
Facility
|
OP
|
$82.85
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
39990148F
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare Advantage |
$39.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.50
|
| Rate for Payer: Cigna Commercial |
$41.42
|
| Rate for Payer: Cigna Medicare Advantage |
$12.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.45
|
| Rate for Payer: EmblemHealth Commercial |
$36.15
|
| Rate for Payer: Humana Medicare Advantage |
$12.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.86
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.20
|
|
|
SENSORY NEUROPATHY ANTIBODY VI
|
Facility
|
IP
|
$82.85
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
39990148F
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.43
|
|
|
SENSORY NEUROPATHY ANTIBODY VI
|
Facility
|
OP
|
$82.85
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
39990148G
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare Advantage |
$39.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.50
|
| Rate for Payer: Cigna Commercial |
$41.42
|
| Rate for Payer: Cigna Medicare Advantage |
$12.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.45
|
| Rate for Payer: EmblemHealth Commercial |
$36.15
|
| Rate for Payer: Humana Medicare Advantage |
$12.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.86
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.20
|
|
|
SENSOSTRIP LCD TEMP INDICATOR
|
Facility
|
OP
|
$2.53
|
|
| Hospital Charge Code |
270642527
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna Commercial |
$0.96
|
| Rate for Payer: Aetna Medicare Advantage |
$0.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.65
|
| Rate for Payer: Cigna Commercial |
$1.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.76
|
| Rate for Payer: Oxford Commercial |
$0.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.51
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.07
|
|
|
SENSOSTRIP LCD TEMP INDICATOR
|
Facility
|
IP
|
$2.53
|
|
| Hospital Charge Code |
270642527
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.38
|
|
|
SEPARATION BY DENSITY RETICS
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86972
|
| Hospital Charge Code |
3100186
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
SEPARATION BY DENSITY RETICS
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86972
|
| Hospital Charge Code |
3100186
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$730.60 |
| Rate for Payer: Aetna Commercial |
$550.53
|
| Rate for Payer: Aetna Medicare Advantage |
$655.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$730.60
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$202.40
|
| Rate for Payer: Clover Medicare Advantage |
$192.28
|
| Rate for Payer: EmblemHealth Commercial |
$607.20
|
| Rate for Payer: Humana Medicare Advantage |
$208.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$202.40
|
| 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 |
$15.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
SEPARATION BY GEL ELECTROPHORE
|
Facility
|
IP
|
$204.00
|
|
| Hospital Charge Code |
3009345A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
|
|
SEPARATION BY GEL ELECTROPHORE
|
Facility
|
IP
|
$204.00
|
|
| Hospital Charge Code |
3004168H
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
|
|
SEPARATION BY GEL ELECTROPHORE
|
Facility
|
OP
|
$204.00
|
|
| Hospital Charge Code |
3009069B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$77.52
|
| Rate for Payer: Aetna Medicare Advantage |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.02
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.41
|
|
|
SEPARATION BY GEL ELECTROPHORE
|
Facility
|
IP
|
$204.00
|
|
| Hospital Charge Code |
3009069B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
|
|
SEPARATION BY GEL ELECTROPHORE
|
Facility
|
IP
|
$204.00
|
|
| Hospital Charge Code |
3032738A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
|
|
SEPARATION BY GEL ELECTROPHORE
|
Facility
|
OP
|
$204.00
|
|
| Hospital Charge Code |
3032738A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$77.52
|
| Rate for Payer: Aetna Medicare Advantage |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.02
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.41
|
|
|
SEPARATION BY GEL ELECTROPHORE
|
Facility
|
OP
|
$204.00
|
|
| Hospital Charge Code |
3004168H
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$77.52
|
| Rate for Payer: Aetna Medicare Advantage |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.02
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.41
|
|
|
SEPARATION BY GEL ELECTROPHORE
|
Facility
|
OP
|
$204.00
|
|
| Hospital Charge Code |
3009345A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$77.52
|
| Rate for Payer: Aetna Medicare Advantage |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.02
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.41
|
|
