|
BILIRUBIN, AMNIOTIC FLUID
|
Facility
|
OP
|
$54.45
|
|
|
Service Code
|
HCPCS 82143
|
| Hospital Charge Code |
3030970
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$25.43
|
| Rate for Payer: Aetna Medicare Advantage |
$30.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.75
|
| Rate for Payer: Cigna Commercial |
$27.23
|
| Rate for Payer: Cigna Medicare Advantage |
$9.35
|
| Rate for Payer: Clover Medicare Advantage |
$8.88
|
| Rate for Payer: EmblemHealth Commercial |
$28.05
|
| Rate for Payer: Humana Medicare Advantage |
$9.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.34
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.44
|
|
|
BILIRUBIN CONJUGATED
|
Facility
|
IP
|
$54.45
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3000440
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$8.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
|
|
BILIRUBIN CONJUGATED
|
Facility
|
OP
|
$54.45
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3000440
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.12
|
| Rate for Payer: Cigna Commercial |
$27.23
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.34
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.44
|
|
|
BILIRUBIN, DIRECT
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
3000445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.12
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.28
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
BILIRUBIN, DIRECT
|
Facility
|
IP
|
$400.40
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
38472143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$60.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.06
|
|
|
BILIRUBIN, DIRECT
|
Facility
|
OP
|
$400.40
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
38472143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.12
|
| Rate for Payer: Cigna Commercial |
$200.20
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$120.12
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.61
|
|
|
BILIRUBIN, DIRECT
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
3000445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
BILIRUBIN,FECES,QUAL
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 82252
|
| Hospital Charge Code |
38477035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.80
|
|
|
BILIRUBIN,FECES,QUAL
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 82252
|
| Hospital Charge Code |
38477035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$12.40
|
| Rate for Payer: Aetna Medicare Advantage |
$14.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.46
|
| Rate for Payer: Cigna Commercial |
$16.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.56
|
| Rate for Payer: Clover Medicare Advantage |
$4.33
|
| Rate for Payer: EmblemHealth Commercial |
$13.68
|
| Rate for Payer: Humana Medicare Advantage |
$4.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.85
|
|
|
BILIRUBIN, NEONATAL DIR & IND
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
3008422
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
BILIRUBIN, NEONATAL DIR & IND
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
3008422
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.12
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.28
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
BILIRUBIN SCAN, AMNIOTIC FLUID
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 82143
|
| Hospital Charge Code |
38473119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$25.43
|
| Rate for Payer: Aetna Medicare Advantage |
$30.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.75
|
| Rate for Payer: Cigna Commercial |
$90.00
|
| Rate for Payer: Cigna Medicare Advantage |
$9.35
|
| Rate for Payer: Clover Medicare Advantage |
$8.88
|
| Rate for Payer: EmblemHealth Commercial |
$28.05
|
| Rate for Payer: Humana Medicare Advantage |
$9.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.77
|
|
|
BILIRUBIN SCAN, AMNIOTIC FLUID
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 82143
|
| Hospital Charge Code |
38473119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
|
|
BILIRUBIN (STOOL)***
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
3007853
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$10.26
|
| Rate for Payer: Aetna Medicare Advantage |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.88
|
| Rate for Payer: Cigna Commercial |
$13.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.72
|
|
|
BILIRUBIN (STOOL)***
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
3007853
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.05
|
|
|
BILIRUBIN, STOOL
|
Facility
|
IP
|
$54.45
|
|
|
Service Code
|
HCPCS 82252
|
| Hospital Charge Code |
3003853
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$8.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
|
|
BILIRUBIN, STOOL
|
Facility
|
OP
|
$54.45
|
|
|
Service Code
|
HCPCS 82252
|
| Hospital Charge Code |
3003853
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$12.40
|
| Rate for Payer: Aetna Medicare Advantage |
$14.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.46
|
| Rate for Payer: Cigna Commercial |
$27.23
|
| Rate for Payer: Cigna Medicare Advantage |
$4.56
|
| Rate for Payer: Clover Medicare Advantage |
$4.33
|
| Rate for Payer: EmblemHealth Commercial |
$13.68
|
| Rate for Payer: Humana Medicare Advantage |
$4.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.34
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.44
|
|
|
BILIRUBIN TOTAL
|
Facility
|
OP
|
$54.45
|
|
|
Service Code
|
HCPCS 82247CF
|
| Hospital Charge Code |
8200302RS
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$20.69
|
| Rate for Payer: Aetna Medicare Advantage |
$16.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.88
|
| Rate for Payer: Cigna Commercial |
$27.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.34
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.44
|
|
|
BILIRUBIN TOTAL
|
Facility
|
IP
|
$54.45
|
|
|
Service Code
|
HCPCS 82247CF
|
| Hospital Charge Code |
8200302RS
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$8.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
|
|
BILIRUBIN TOTAL***
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
3010436
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.85
|
|
|
BILIRUBIN TOTAL***
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
3010436
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna Medicare Advantage |
$5.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.84
|
| Rate for Payer: Cigna Commercial |
$9.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.50
|
|
|
BILIRUBIN, TOTAL
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3000437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
BILIRUBIN, TOTAL
|
Facility
|
OP
|
$54.45
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
8200351RS
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.12
|
| Rate for Payer: Cigna Commercial |
$27.23
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.34
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.44
|
|
|
BILIRUBIN, TOTAL
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3000437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.12
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.28
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
BILIRUBIN, TOTAL
|
Facility
|
IP
|
$54.45
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
8200351RS
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$8.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
|
