|
AFB IDENTIFICATION
|
Facility
|
OP
|
$96.85
|
|
|
Service Code
|
HCPCS 87118
|
| Hospital Charge Code |
3006798
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$47.34
|
| Rate for Payer: Aetna Medicare Advantage |
$14.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.53
|
| Rate for Payer: Cigna Commercial |
$14.61
|
| Rate for Payer: Cigna Medicare Advantage |
$7.30
|
| Rate for Payer: Clover Medicare Advantage |
$13.88
|
| Rate for Payer: EmblemHealth Commercial |
$43.83
|
| Rate for Payer: Humana Medicare Advantage |
$15.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.59
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.61
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.61
|
|
|
AFB ID HPLC-FL and CONVENT
|
Facility
|
IP
|
$86.10
|
|
|
Service Code
|
HCPCS 87143
|
| Hospital Charge Code |
39990164B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.91
|
|
|
AFB ID HPLC-FL and CONVENT
|
Facility
|
IP
|
$86.10
|
|
|
Service Code
|
HCPCS 87143
|
| Hospital Charge Code |
39990164A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.91
|
|
|
AFB ID HPLC-FL and CONVENT
|
Facility
|
OP
|
$86.10
|
|
|
Service Code
|
HCPCS 87143
|
| Hospital Charge Code |
39990164B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: Aetna Medicare Advantage |
$12.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.87
|
| Rate for Payer: Cigna Commercial |
$12.52
|
| Rate for Payer: Cigna Medicare Advantage |
$6.26
|
| Rate for Payer: Clover Medicare Advantage |
$11.89
|
| Rate for Payer: EmblemHealth Commercial |
$37.56
|
| Rate for Payer: Humana Medicare Advantage |
$12.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.19
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.52
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$13.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.52
|
|
|
AFB ID HPLC-FL and CONVENT
|
Facility
|
OP
|
$86.10
|
|
|
Service Code
|
HCPCS 87143
|
| Hospital Charge Code |
39990164A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: Aetna Medicare Advantage |
$12.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.87
|
| Rate for Payer: Cigna Commercial |
$12.52
|
| Rate for Payer: Cigna Medicare Advantage |
$6.26
|
| Rate for Payer: Clover Medicare Advantage |
$11.89
|
| Rate for Payer: EmblemHealth Commercial |
$37.56
|
| Rate for Payer: Humana Medicare Advantage |
$12.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.19
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.52
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$13.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.52
|
|
|
AFB ID HPLC-FL & CONVENTI
|
Facility
|
OP
|
$86.10
|
|
|
Service Code
|
HCPCS 87143
|
| Hospital Charge Code |
39900272
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: Aetna Medicare Advantage |
$12.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.87
|
| Rate for Payer: Cigna Commercial |
$12.52
|
| Rate for Payer: Cigna Medicare Advantage |
$6.26
|
| Rate for Payer: Clover Medicare Advantage |
$11.89
|
| Rate for Payer: EmblemHealth Commercial |
$37.56
|
| Rate for Payer: Humana Medicare Advantage |
$12.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.19
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.52
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$13.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.52
|
|
|
AFB ID HPLC-FL & CONVENTI
|
Facility
|
IP
|
$86.10
|
|
|
Service Code
|
HCPCS 87143
|
| Hospital Charge Code |
39900272
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.91
|
|
|
AFB SENS
|
Facility
|
OP
|
$40.85
|
|
|
Service Code
|
HCPCS 87190
|
| Hospital Charge Code |
3006516B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cigna Commercial |
$7.31
|
| Rate for Payer: Cigna Medicare Advantage |
$3.65
|
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.78
|
| Rate for Payer: Clover Medicare Advantage |
$6.94
|
| Rate for Payer: EmblemHealth Commercial |
$21.93
|
| Rate for Payer: Humana Medicare Advantage |
$7.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.31
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.31
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$7.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.31
|
|
|
AFB SENS
|
Facility
|
IP
|
$40.85
|
|
|
Service Code
|
HCPCS 87190
|
| Hospital Charge Code |
3006516B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.13
|
|
|
AFB SENS
|
Facility
|
OP
|
$40.85
|
|
|
Service Code
|
HCPCS 87190
|
| Hospital Charge Code |
3006516D
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.78
|
| Rate for Payer: Cigna Commercial |
$7.31
|
| Rate for Payer: Cigna Medicare Advantage |
$3.65
|
| Rate for Payer: Clover Medicare Advantage |
$6.94
|
| Rate for Payer: EmblemHealth Commercial |
$21.93
|
| Rate for Payer: Humana Medicare Advantage |
$7.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.31
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.31
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$7.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.31
|
|
|
AFB SENS
|
Facility
|
IP
|
$40.85
|
|
|
Service Code
|
HCPCS 87190
|
| Hospital Charge Code |
3006516A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.13
|
|
|
AFB SENS
|
Facility
|
IP
|
$40.85
|
|
|
Service Code
|
HCPCS 87190
|
| Hospital Charge Code |
3006516C
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.13
|
|
|
AFB SENS
|
Facility
|
OP
|
$40.85
|
|
|
Service Code
|
HCPCS 87190
|
| Hospital Charge Code |
3006516C
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.78
|
| Rate for Payer: Cigna Commercial |
$7.31
|
| Rate for Payer: Cigna Medicare Advantage |
$3.65
|
| Rate for Payer: Clover Medicare Advantage |
$6.94
|
| Rate for Payer: EmblemHealth Commercial |
$21.93
|
| Rate for Payer: Humana Medicare Advantage |
$7.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.31
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.31
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$7.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.31
|
|
|
AFB SENS
|
Facility
|
IP
|
$40.85
|
|
|
Service Code
|
HCPCS 87190
|
| Hospital Charge Code |
3006516D
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.13
|
|
|
AFB SENS
|
Facility
|
OP
|
$40.85
|
|
|
Service Code
|
HCPCS 87190
|
| Hospital Charge Code |
3006516A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.78
|
| Rate for Payer: Cigna Commercial |
$7.31
|
| Rate for Payer: Cigna Medicare Advantage |
$3.65
|
| Rate for Payer: Clover Medicare Advantage |
$6.94
|
| Rate for Payer: EmblemHealth Commercial |
$21.93
|
| Rate for Payer: Humana Medicare Advantage |
$7.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.31
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.31
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$7.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.31
|
|
|
AFB SENSITIVITIES, I
|
Facility
|
IP
|
$38.85
|
|
|
Service Code
|
HCPCS 8719091
|
| Hospital Charge Code |
39990053A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.83
|
|
|
AFB SENSITIVITIES, I
|
Facility
|
OP
|
$38.85
|
|
|
Service Code
|
HCPCS 8719091
|
| Hospital Charge Code |
39990053A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$11.65
|
| Rate for Payer: Aetna Medicare Advantage |
$11.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.91
|
| Rate for Payer: Cigna Commercial |
$19.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.05
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
AFB SENSITIVITIES, II
|
Facility
|
OP
|
$38.85
|
|
|
Service Code
|
HCPCS 8719091
|
| Hospital Charge Code |
39990053B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$11.65
|
| Rate for Payer: Aetna Medicare Advantage |
$11.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.91
|
| Rate for Payer: Cigna Commercial |
$19.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.05
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
AFB SENSITIVITIES, II
|
Facility
|
IP
|
$38.85
|
|
|
Service Code
|
HCPCS 8719091
|
| Hospital Charge Code |
39990053B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.83
|
|
|
AFB SENSITIVITIES, III
|
Facility
|
OP
|
$38.85
|
|
|
Service Code
|
HCPCS 8719091
|
| Hospital Charge Code |
39990053C
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$11.65
|
| Rate for Payer: Aetna Medicare Advantage |
$11.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.91
|
| Rate for Payer: Cigna Commercial |
$19.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.05
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
AFB SENSITIVITIES, III
|
Facility
|
IP
|
$38.85
|
|
|
Service Code
|
HCPCS 8719091
|
| Hospital Charge Code |
39990053C
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.83
|
|
|
AFB SENSITIVITIES, IV
|
Facility
|
OP
|
$38.85
|
|
|
Service Code
|
HCPCS 8719091
|
| Hospital Charge Code |
39990053D
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$11.65
|
| Rate for Payer: Aetna Medicare Advantage |
$11.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.91
|
| Rate for Payer: Cigna Commercial |
$19.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.05
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
AFB SENSITIVITIES, IV
|
Facility
|
IP
|
$38.85
|
|
|
Service Code
|
HCPCS 8719091
|
| Hospital Charge Code |
39990053D
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.83
|
|
|
AFB SENSITIVITIES, V
|
Facility
|
OP
|
$38.85
|
|
|
Service Code
|
HCPCS 8719091
|
| Hospital Charge Code |
39990053E
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$11.65
|
| Rate for Payer: Aetna Medicare Advantage |
$11.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.91
|
| Rate for Payer: Cigna Commercial |
$19.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.05
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
AFB SENSITIVITIES, V
|
Facility
|
IP
|
$38.85
|
|
|
Service Code
|
HCPCS 8719091
|
| Hospital Charge Code |
39990053E
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.83
|
|