|
CADASIL
|
Facility
|
OP
|
$128.00
|
|
| Hospital Charge Code |
3035094H
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna Medicare Advantage |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.64
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
|
CADASIL
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
3035094Y
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
CADASIL
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
3035094M
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
CADASIL
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
3035094R
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna Medicare Advantage |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.86
|
| Rate for Payer: Cigna Commercial |
$60.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.21
|
|
|
CADASIL
|
Facility
|
OP
|
$128.00
|
|
| Hospital Charge Code |
3035094F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna Medicare Advantage |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.64
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
|
CADASIL
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
3035094Z
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
CADASIL
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
3035094S
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna Medicare Advantage |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.86
|
| Rate for Payer: Cigna Commercial |
$60.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.21
|
|
|
CADASIL
|
Facility
|
OP
|
$3,772.75
|
|
|
Service Code
|
HCPCS 81406
|
| Hospital Charge Code |
3035094
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$99.98 |
| Max. Negotiated Rate |
$1,886.38 |
| Rate for Payer: Aetna Commercial |
$769.43
|
| Rate for Payer: Aetna Medicare Advantage |
$916.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,021.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,021.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,021.11
|
| Rate for Payer: Cigna Commercial |
$1,886.38
|
| Rate for Payer: Cigna Medicare Advantage |
$282.88
|
| Rate for Payer: Clover Medicare Advantage |
$268.74
|
| Rate for Payer: EmblemHealth Commercial |
$848.64
|
| Rate for Payer: Humana Medicare Advantage |
$291.37
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$282.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,131.83
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$565.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$226.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$282.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$282.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$99.98
|
|
|
CADASIL
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
3035094AC
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
CADASIL
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
3035094T
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
CADASIL
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
3035094AA
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
CADASIL
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
3035094G
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
CADASIL
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
3035094D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
CADASIL
|
Facility
|
OP
|
$128.00
|
|
| Hospital Charge Code |
3035094G
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna Medicare Advantage |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.64
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
|
CADASIL
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
3035094N
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
CADASIL
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
3035094AE
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna Medicare Advantage |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.86
|
| Rate for Payer: Cigna Commercial |
$60.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.21
|
|
|
CADASIL
|
Facility
|
IP
|
$3,772.75
|
|
|
Service Code
|
HCPCS 81406
|
| Hospital Charge Code |
3035094
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$565.91 |
| Max. Negotiated Rate |
$565.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$565.91
|
|
|
CADASIL
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
3035094V
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
CADASIL
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
3035094H
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
CADASIL
|
Facility
|
OP
|
$390.00
|
|
| Hospital Charge Code |
3035094X
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.45
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| 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 |
$9.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CADASIL
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
3035094AE
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
CADASIL
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
3035094E
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
CADASIL
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
3035094AD
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna Medicare Advantage |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.86
|
| Rate for Payer: Cigna Commercial |
$60.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.21
|
|
|
CADASIL
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
3035094R
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
CADASIL
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
3035094W
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna Medicare Advantage |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.86
|
| Rate for Payer: Cigna Commercial |
$60.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.21
|
|