|
CARRY GOAL STATUS CN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8985GPCN
|
| Hospital Charge Code |
84202035CN
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
CARRY GOAL STATUS CN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8985GOCN
|
| Hospital Charge Code |
74203101CN
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
CARRY GOAL STATUS CN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8985GPCN
|
| Hospital Charge Code |
84202035CN
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$116.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
CARRY GOAL STATUS CN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8985GOCN
|
| Hospital Charge Code |
74203101CN
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$116.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
CAR SEAT/BED TEST 60 MIN
|
Facility
|
OP
|
$186.45
|
|
|
Service Code
|
HCPCS 94780
|
| Hospital Charge Code |
309194780
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$120.69
|
| Rate for Payer: Aetna Medicare Advantage |
$143.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.16
|
| Rate for Payer: Cigna Commercial |
$88.94
|
| Rate for Payer: Cigna Medicare Advantage |
$44.37
|
| Rate for Payer: Clover Medicare Advantage |
$42.15
|
| Rate for Payer: EmblemHealth Commercial |
$133.11
|
| Rate for Payer: Humana Medicare Advantage |
$45.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$44.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.94
|
| Rate for Payer: Oxford Commercial |
$885.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$44.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.94
|
|
|
CAR SEAT/BED TEST 60 MIN
|
Facility
|
OP
|
$186.45
|
|
|
Service Code
|
HCPCS 94780
|
| Hospital Charge Code |
309094780
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$120.69
|
| Rate for Payer: Aetna Medicare Advantage |
$143.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.16
|
| Rate for Payer: Cigna Commercial |
$88.94
|
| Rate for Payer: Cigna Medicare Advantage |
$44.37
|
| Rate for Payer: Clover Medicare Advantage |
$42.15
|
| Rate for Payer: EmblemHealth Commercial |
$133.11
|
| Rate for Payer: Humana Medicare Advantage |
$45.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$44.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.94
|
| Rate for Payer: Oxford Commercial |
$885.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$44.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.94
|
|
|
CAR SEAT/BED TEST 60 MIN
|
Facility
|
IP
|
$186.45
|
|
|
Service Code
|
HCPCS 94780
|
| Hospital Charge Code |
309194780
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$27.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.97
|
|
|
CAR SEAT/BED TEST 60 MIN
|
Facility
|
IP
|
$186.45
|
|
|
Service Code
|
HCPCS 94780
|
| Hospital Charge Code |
309094780
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$27.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.97
|
|
|
CAR SEAT/BED TEST 60 MIN
|
Facility
|
OP
|
$186.45
|
|
|
Service Code
|
HCPCS 94780
|
| Hospital Charge Code |
309294780
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$120.69
|
| Rate for Payer: Aetna Medicare Advantage |
$143.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.16
|
| Rate for Payer: Cigna Commercial |
$88.94
|
| Rate for Payer: Cigna Medicare Advantage |
$44.37
|
| Rate for Payer: Clover Medicare Advantage |
$42.15
|
| Rate for Payer: EmblemHealth Commercial |
$133.11
|
| Rate for Payer: Humana Medicare Advantage |
$45.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$44.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.94
|
| Rate for Payer: Oxford Commercial |
$885.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$44.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.94
|
|
|
CAR SEAT/BED TEST 60 MIN
|
Facility
|
IP
|
$186.45
|
|
|
Service Code
|
HCPCS 94780
|
| Hospital Charge Code |
309294780
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$27.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.97
|
|
|
CAR SEAT/BED TEST EA ADD 30MIN
|
Facility
|
IP
|
$93.23
|
|
|
Service Code
|
HCPCS 94781
|
| Hospital Charge Code |
309094781
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$13.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.98
|
|
|
CAR SEAT/BED TEST EA ADD 30MIN
|
Facility
|
OP
|
$93.23
|
|
|
Service Code
|
HCPCS 94781
|
| Hospital Charge Code |
309094781
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$35.43
|
| Rate for Payer: Aetna Medicare Advantage |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.77
|
| Rate for Payer: Cigna Commercial |
$46.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.97
|
| Rate for Payer: Oxford Commercial |
$885.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.47
|
|
|
CAR SEAT/BED TEST EA ADD 30MIN
|
Facility
|
IP
|
$93.23
|
|
|
Service Code
|
HCPCS 94781
|
| Hospital Charge Code |
309194781
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$13.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.98
|
|
|
CAR SEAT/BED TEST EA ADD 30MIN
|
Facility
|
OP
|
$93.23
|
|
|
Service Code
|
HCPCS 94781
|
| Hospital Charge Code |
309194781
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$35.43
|
| Rate for Payer: Aetna Medicare Advantage |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.77
|
| Rate for Payer: Cigna Commercial |
$46.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.97
|
| Rate for Payer: Oxford Commercial |
$885.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.47
|
|
|
CAR SEAT/BED TEST EA ADD 30MIN
|
Facility
|
IP
|
$93.23
|
|
|
Service Code
|
HCPCS 94781
|
| Hospital Charge Code |
309294781
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$13.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.98
|
|
|
CAR SEAT/BED TEST EA ADD 30MIN
|
Facility
|
OP
|
$93.23
|
|
|
Service Code
|
HCPCS 94781
|
| Hospital Charge Code |
309294781
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$35.43
|
| Rate for Payer: Aetna Medicare Advantage |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.77
|
| Rate for Payer: Cigna Commercial |
$46.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.97
|
| Rate for Payer: Oxford Commercial |
$885.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.47
|
|
|
CART COVER, CELAR VINLY, FRONT
|
Facility
|
OP
|
$420.00
|
|
| Hospital Charge Code |
270665559
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.10
|
| Rate for Payer: Cigna Commercial |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$126.00
|
| Rate for Payer: Oxford Commercial |
$84.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$84.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.13
|
|
|
CART COVER, CELAR VINLY, FRONT
|
Facility
|
IP
|
$420.00
|
|
| Hospital Charge Code |
270665559
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
|
|
Cart Cover for Model SP-30SL C
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
270665973
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.00
|
|
|
Cart Cover for Model SP-30SL C
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
270665973
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna Commercial |
$220.40
|
| Rate for Payer: Aetna Medicare Advantage |
$174.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$147.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$147.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$147.90
|
| Rate for Payer: Cigna Commercial |
$290.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.00
|
| Rate for Payer: Oxford Commercial |
$116.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$116.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.37
|
|
|
CARTDRIDGE NITROUS OXIDE
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
270679447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.00
|
| Rate for Payer: Oxford Commercial |
$60.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$60.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.95
|
|
|
CARTDRIDGE NITROUS OXIDE
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
270679447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
CART FOR MODEL
|
Facility
|
OP
|
$3,802.85
|
|
| Hospital Charge Code |
270658990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$1,901.42 |
| Rate for Payer: Aetna Commercial |
$1,445.08
|
| Rate for Payer: Aetna Medicare Advantage |
$1,140.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$969.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$969.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$969.73
|
| Rate for Payer: Cigna Commercial |
$1,901.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,140.86
|
| Rate for Payer: Oxford Commercial |
$760.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$570.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$760.57
|
| Rate for Payer: UnitedHealthcare Community & State |
$91.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$100.78
|
|
|
CART FOR MODEL
|
Facility
|
IP
|
$3,802.85
|
|
| Hospital Charge Code |
270658990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.43 |
| Max. Negotiated Rate |
$570.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$570.43
|
|
|
CARTICEL BIOPSY TRANSPORT KIT
|
Facility
|
OP
|
$2,475.00
|
|
| Hospital Charge Code |
270657891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.65 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$940.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$742.50
|
| Rate for Payer: Oxford Commercial |
$495.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$495.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$65.59
|
|
