|
BILIRUBIN TOTAL BODY FLUID
|
Facility
|
OP
|
$123.20
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
401182247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.26 |
| 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 |
$61.60
|
| 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 |
$36.96
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.48
|
| 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 |
$3.26
|
|
|
BILIRUBIN TOTAL BODY FLUID
|
Facility
|
IP
|
$123.20
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
401182247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$18.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.48
|
|
|
BILIRUBIN,TOTAL,VAN DEN BERGH
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
38472140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
BILIRUBIN,TOTAL,VAN DEN BERGH
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
38472140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| 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 |
$122.50
|
| 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 |
$73.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
| 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 |
$6.49
|
|
|
BILIRUBIN T TRANS IMMEDIATE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3000438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BILIRUBIN T TRANS IMMEDIATE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3000438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$195.00
|
| 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 |
$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 |
$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 |
$10.34
|
|
|
BILIRUBIN, URINE
|
Facility
|
IP
|
$22.45
|
|
|
Service Code
|
HCPCS 81005
|
| Hospital Charge Code |
3003878
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.37
|
|
|
BILIRUBIN, URINE
|
Facility
|
OP
|
$22.45
|
|
|
Service Code
|
HCPCS 81005
|
| Hospital Charge Code |
3003878
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$5.90
|
| Rate for Payer: Aetna Medicare Advantage |
$7.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.83
|
| Rate for Payer: Cigna Commercial |
$11.22
|
| Rate for Payer: Cigna Medicare Advantage |
$2.17
|
| Rate for Payer: Clover Medicare Advantage |
$2.06
|
| Rate for Payer: EmblemHealth Commercial |
$6.51
|
| Rate for Payer: Humana Medicare Advantage |
$2.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.74
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.59
|
|
|
BILI TRANS POST
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
300439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BILI TRANS POST
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
300439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$195.00
|
| 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 |
$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 |
$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 |
$10.34
|
|
|
BILL ADMIN COMPONENT 1-6 UNITS
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3100468
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$12.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.30
|
|
|
BILL ADMIN COMPONENT 1-6 UNITS
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3100468
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$1,891.95 |
| Rate for Payer: Aetna Commercial |
$1,425.63
|
| Rate for Payer: Aetna Medicare Advantage |
$1,698.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,891.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,891.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$524.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,891.95
|
| Rate for Payer: Cigna Commercial |
$1,050.61
|
| Rate for Payer: Cigna Medicare Advantage |
$524.13
|
| Rate for Payer: Clover Medicare Advantage |
$497.92
|
| Rate for Payer: EmblemHealth Commercial |
$1,572.39
|
| Rate for Payer: Humana Medicare Advantage |
$539.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$524.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.60
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$524.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$524.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.17
|
|
|
BILL AG SCREEN BLD UNIIT, IGG
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
3100211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BILL AG SCREEN BLD UNIIT, IGG
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
3100211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$853.60 |
| Rate for Payer: Aetna Commercial |
$10.42
|
| Rate for Payer: Aetna Medicare Advantage |
$12.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.83
|
| Rate for Payer: Cigna Commercial |
$853.60
|
| Rate for Payer: Cigna Medicare Advantage |
$3.83
|
| Rate for Payer: Clover Medicare Advantage |
$3.64
|
| Rate for Payer: EmblemHealth Commercial |
$11.49
|
| Rate for Payer: Humana Medicare Advantage |
$3.94
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.83
|
| 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 |
$3.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
BILL AG SCREEN PATIENT, IGG
|
Facility
|
OP
|
$309.65
|
|
|
Service Code
|
HCPCS 86904
|
| Hospital Charge Code |
3100419
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$140.48 |
| Rate for Payer: Aetna Commercial |
$44.44
|
| Rate for Payer: Aetna Medicare Advantage |
$52.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.98
|
| Rate for Payer: Cigna Commercial |
$140.48
|
| Rate for Payer: Cigna Medicare Advantage |
$16.34
|
| Rate for Payer: Clover Medicare Advantage |
$15.52
|
| Rate for Payer: EmblemHealth Commercial |
$49.02
|
| Rate for Payer: Humana Medicare Advantage |
$16.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$92.89
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.21
|
|
|
BILL AG SCREEN PATIENT, IGG
|
Facility
|
IP
|
$309.65
|
|
|
Service Code
|
HCPCS 86904
|
| Hospital Charge Code |
3100419
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$46.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.45
|
|
|
BILL ANTIGEN NEG-BLOOD, GNYBP
|
Facility
|
IP
|
$220.85
|
|
|
Service Code
|
HCPCS 86921
|
| Hospital Charge Code |
3100484
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$33.13 |
| Max. Negotiated Rate |
$33.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.13
|
|
|
BILL ANTIGEN NEG-BLOOD, GNYBP
|
Facility
|
OP
|
$220.85
|
|
|
Service Code
|
HCPCS 86921
|
| Hospital Charge Code |
3100484
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.85 |
| 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 |
$25.56
|
| 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 |
$66.25
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.85
|
|
|
BILL ANTIGEN NEG BLOOD,NOJBC
|
Facility
|
OP
|
$220.85
|
|
|
Service Code
|
HCPCS 86921
|
| Hospital Charge Code |
3100476
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.85 |
| 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 |
$25.56
|
| 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 |
$66.25
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.85
|
|
|
BILL ANTIGEN NEG BLOOD,NOJBC
|
Facility
|
IP
|
$220.85
|
|
|
Service Code
|
HCPCS 86921
|
| Hospital Charge Code |
3100476
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$33.13 |
| Max. Negotiated Rate |
$33.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.13
|
|
|
BILL BLOOD ADMINISTRATION
|
Facility
|
OP
|
$1,403.75
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3100054
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$33.83 |
| Max. Negotiated Rate |
$1,891.95 |
| Rate for Payer: Aetna Commercial |
$1,425.63
|
| Rate for Payer: Aetna Medicare Advantage |
$1,698.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,891.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,891.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$524.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,891.95
|
| Rate for Payer: Cigna Commercial |
$1,050.61
|
| Rate for Payer: Cigna Medicare Advantage |
$524.13
|
| Rate for Payer: Clover Medicare Advantage |
$497.92
|
| Rate for Payer: EmblemHealth Commercial |
$1,572.39
|
| Rate for Payer: Humana Medicare Advantage |
$539.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$524.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$421.12
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$524.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$524.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.20
|
|
|
BILL BLOOD ADMINISTRATION
|
Facility
|
IP
|
$1,403.75
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3100054
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$210.56 |
| Max. Negotiated Rate |
$210.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.56
|
|
|
BILL CMV NEG BLOOD ORDER
|
Facility
|
IP
|
$188.85
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
3100500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$28.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.33
|
|
|
BILL CMV NEG BLOOD ORDER
|
Facility
|
OP
|
$188.85
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
3100500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare Advantage |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.39
|
| 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 |
$51.94
|
| Rate for Payer: Cigna Commercial |
$94.42
|
| Rate for Payer: Cigna Medicare Advantage |
$14.39
|
| Rate for Payer: Clover Medicare Advantage |
$13.67
|
| Rate for Payer: EmblemHealth Commercial |
$43.17
|
| Rate for Payer: Humana Medicare Advantage |
$14.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.66
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.00
|
|
|
BILL FFP
|
Facility
|
IP
|
$170.25
|
|
| Hospital Charge Code |
3100021
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$25.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.54
|
|
