|
VEEG 12-26HRS CONT MON
|
Facility
|
OP
|
$5,322.08
|
|
|
Service Code
|
HCPCS 95716
|
| Hospital Charge Code |
403395716
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$128.26 |
| Max. Negotiated Rate |
$5,944.00 |
| Rate for Payer: Aetna Commercial |
$2,774.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,305.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,682.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,682.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,020.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,682.65
|
| Rate for Payer: Cigna Commercial |
$2,044.99
|
| Rate for Payer: Cigna Medicare Advantage |
$1,020.21
|
| Rate for Payer: Clover Medicare Advantage |
$969.20
|
| Rate for Payer: EmblemHealth Commercial |
$3,060.63
|
| Rate for Payer: Humana Medicare Advantage |
$1,050.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,020.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,596.62
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$798.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,944.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$128.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,020.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,020.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$141.04
|
|
|
VEEG 12-26HRS INT MON
|
Facility
|
IP
|
$2,843.33
|
|
|
Service Code
|
HCPCS 95715
|
| Hospital Charge Code |
403395715
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$426.50 |
| Max. Negotiated Rate |
$426.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$426.50
|
|
|
VEEG 12-26HRS INT MON
|
Facility
|
OP
|
$2,843.33
|
|
|
Service Code
|
HCPCS 95715
|
| Hospital Charge Code |
403395715
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$5,944.00 |
| 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) 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 |
$853.00
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$426.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,944.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$75.35
|
|
|
VEEG 12-26HRS INT MON
|
Facility
|
IP
|
$2,843.33
|
|
|
Service Code
|
HCPCS 95715
|
| Hospital Charge Code |
405295715
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$426.50 |
| Max. Negotiated Rate |
$426.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$426.50
|
|
|
VEEG 12-26HRS INT MON
|
Facility
|
OP
|
$2,843.33
|
|
|
Service Code
|
HCPCS 95715
|
| Hospital Charge Code |
405295715
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$5,944.00 |
| 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) 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 |
$853.00
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$426.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,944.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$75.35
|
|
|
VEEG 12-26HRS UNMON
|
Facility
|
IP
|
$2,843.33
|
|
|
Service Code
|
HCPCS 95714
|
| Hospital Charge Code |
405295714
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$426.50 |
| Max. Negotiated Rate |
$426.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$426.50
|
|
|
VEEG 12-26HRS UNMON
|
Facility
|
IP
|
$2,843.33
|
|
|
Service Code
|
HCPCS 95714
|
| Hospital Charge Code |
403395714
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$426.50 |
| Max. Negotiated Rate |
$426.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$426.50
|
|
|
VEEG 12-26HRS UNMON
|
Facility
|
OP
|
$2,843.33
|
|
|
Service Code
|
HCPCS 95714
|
| Hospital Charge Code |
403395714
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$5,944.00 |
| 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) 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 |
$853.00
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$426.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,944.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$75.35
|
|
|
VEEG 12-26HRS UNMON
|
Facility
|
OP
|
$2,843.33
|
|
|
Service Code
|
HCPCS 95714
|
| Hospital Charge Code |
405295714
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$5,944.00 |
| 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) 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 |
$853.00
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$426.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,944.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$75.35
|
|
|
VEEG 2-12HRS CONT MON
|
Facility
|
IP
|
$2,843.33
|
|
|
Service Code
|
HCPCS 95713
|
| Hospital Charge Code |
405295713
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$426.50 |
| Max. Negotiated Rate |
$426.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$426.50
|
|
|
VEEG 2-12HRS CONT MON
|
Facility
|
OP
|
$2,843.33
|
|
|
Service Code
|
HCPCS 95713
|
| Hospital Charge Code |
405295713
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$5,944.00 |
| 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) 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 |
$853.00
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$426.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,944.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$75.35
|
|
|
VEEG 2-12HRS CONT MON
|
Facility
|
OP
|
$2,843.33
|
|
|
Service Code
|
HCPCS 95713
|
| Hospital Charge Code |
403395713
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$5,944.00 |
| 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) 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 |
$853.00
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$426.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,944.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$75.35
|
|
|
VEEG 2-12HRS CONT MON
|
Facility
|
IP
|
$2,843.33
|
|
|
Service Code
|
HCPCS 95713
|
| Hospital Charge Code |
403395713
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$426.50 |
| Max. Negotiated Rate |
$426.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$426.50
|
|
|
VEEG 2-12HRS INT MON
|
Facility
|
OP
|
$1,481.95
|
|
|
Service Code
|
HCPCS 95712
|
| Hospital Charge Code |
405295712
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$35.71 |
| Max. Negotiated Rate |
$5,944.00 |
| 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) 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 |
$444.58
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$222.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,944.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.27
|
|
|
VEEG 2-12HRS INT MON
|
Facility
|
IP
|
$1,481.95
|
|
|
Service Code
|
HCPCS 95712
|
| Hospital Charge Code |
403395712
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$222.29 |
| Max. Negotiated Rate |
$222.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$222.29
|
|
|
VEEG 2-12HRS INT MON
|
Facility
|
IP
|
$1,481.95
|
|
|
Service Code
|
HCPCS 95712
|
| Hospital Charge Code |
405295712
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$222.29 |
| Max. Negotiated Rate |
$222.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$222.29
|
|
|
VEEG 2-12HRS INT MON
|
Facility
|
OP
|
$1,481.95
|
|
|
Service Code
|
HCPCS 95712
|
| Hospital Charge Code |
403395712
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$35.71 |
| Max. Negotiated Rate |
$5,944.00 |
| 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) 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 |
$444.58
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$222.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,944.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$443.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.27
|
|
|
VEEG 2-12HRS UNMON
|
Facility
|
IP
|
$1,481.95
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
405295711
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$222.29 |
| Max. Negotiated Rate |
$222.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$222.29
|
|
|
VEEG 2-12HRS UNMON
|
Facility
|
OP
|
$1,481.95
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
405295711
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$35.71 |
| Max. Negotiated Rate |
$5,944.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$444.58
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$222.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,944.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.27
|
|
|
VEEG 2-12HRS UNMON
|
Facility
|
IP
|
$1,481.95
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
403395711
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$222.29 |
| Max. Negotiated Rate |
$222.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$222.29
|
|
|
VEEG 2-12HRS UNMON
|
Facility
|
OP
|
$1,481.95
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
403395711
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$35.71 |
| Max. Negotiated Rate |
$5,944.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$444.58
|
| Rate for Payer: Oxford Commercial |
$3,390.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$222.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,944.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.27
|
|
|
VEGF ELISA
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3003100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$195.00
|
| 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 |
$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 |
$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 |
$10.34
|
|
|
VEGF ELISA
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3003100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
VEIN 77cm SAPHAN CRYOPRE 67404
|
Facility
|
OP
|
$38,030.00
|
|
| Hospital Charge Code |
270642485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.52 |
| Max. Negotiated Rate |
$19,015.00 |
| Rate for Payer: Aetna Commercial |
$14,451.40
|
| Rate for Payer: Aetna Medicare Advantage |
$11,409.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,697.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,697.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,606.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,697.65
|
| Rate for Payer: Cigna Commercial |
$19,015.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,203.26
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,366.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,704.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$916.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,007.79
|
|
|
VEIN 77cm SAPHAN CRYOPRE 67404
|
Facility
|
IP
|
$38,030.00
|
|
| Hospital Charge Code |
270642485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,704.50 |
| Max. Negotiated Rate |
$9,203.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,606.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,203.26
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,366.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,704.50
|
|
