|
CRYPTOSPORIDIUM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS 87328
|
| Hospital Charge Code |
38475104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$26.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.70
|
|
|
CRYPTOSPORIDIUM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS 87328
|
| Hospital Charge Code |
38475104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$44.78
|
| Rate for Payer: Aetna Medicare Advantage |
$13.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$50.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$50.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$50.64
|
| Rate for Payer: Cigna Commercial |
$13.82
|
| Rate for Payer: Cigna Medicare Advantage |
$6.91
|
| Rate for Payer: Clover Medicare Advantage |
$13.13
|
| Rate for Payer: EmblemHealth Commercial |
$41.46
|
| Rate for Payer: Humana Medicare Advantage |
$14.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.14
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.82
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$14.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.82
|
|
|
CRYPTOSPORIDIUM
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
38475038
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$38.82
|
| Rate for Payer: Aetna Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.89
|
| Rate for Payer: Cigna Commercial |
$11.98
|
| Rate for Payer: Cigna Medicare Advantage |
$5.99
|
| Rate for Payer: Clover Medicare Advantage |
$11.38
|
| Rate for Payer: EmblemHealth Commercial |
$35.94
|
| Rate for Payer: Humana Medicare Advantage |
$12.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.29
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
|
|
CRYPTOSPORIDIUM AG,STOOL
|
Facility
|
OP
|
$75.65
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
39900280
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$38.82
|
| Rate for Payer: Aetna Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.89
|
| Rate for Payer: Cigna Commercial |
$11.98
|
| Rate for Payer: Cigna Medicare Advantage |
$5.99
|
| Rate for Payer: Clover Medicare Advantage |
$11.38
|
| Rate for Payer: EmblemHealth Commercial |
$35.94
|
| Rate for Payer: Humana Medicare Advantage |
$12.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.83
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
|
|
CRYPTOSPORIDIUM AG,STOOL
|
Facility
|
IP
|
$75.65
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
39900280
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$11.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.35
|
|
|
CRYPTOSPORIDIUM AG,STOOL I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
3990127A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CRYPTOSPORIDIUM AG,STOOL I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
3990127A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.48
|
| Rate for Payer: Cigna Commercial |
$6.68
|
| Rate for Payer: Cigna Medicare Advantage |
$3.34
|
| Rate for Payer: Clover Medicare Advantage |
$6.35
|
| Rate for Payer: EmblemHealth Commercial |
$20.04
|
| Rate for Payer: Humana Medicare Advantage |
$6.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$7.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.68
|
|
|
CRYPTOSPORIDIUM AG,STOOL II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
3990127B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$38.82
|
| Rate for Payer: Aetna Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.89
|
| Rate for Payer: Cigna Commercial |
$11.98
|
| Rate for Payer: Cigna Medicare Advantage |
$5.99
|
| Rate for Payer: Clover Medicare Advantage |
$11.38
|
| Rate for Payer: EmblemHealth Commercial |
$35.94
|
| Rate for Payer: Humana Medicare Advantage |
$12.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
|
|
CRYPTOSPORIDIUM AG,STOOL II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
3990127B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CRYPTOSPORIDIUM SMEAR
|
Facility
|
OP
|
$133.65
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
3009297
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna Medicare Advantage |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.95
|
| Rate for Payer: Cigna Commercial |
$5.99
|
| Rate for Payer: Cigna Medicare Advantage |
$3.00
|
| Rate for Payer: Clover Medicare Advantage |
$5.69
|
| Rate for Payer: EmblemHealth Commercial |
$17.97
|
| Rate for Payer: Humana Medicare Advantage |
$6.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.37
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$6.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.99
|
|
|
CRYPTOSPORIDIUM SMEAR
|
Facility
|
IP
|
$133.65
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
3009297
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.05
|
|
|
CRYPTOSPORODIUM AG, STOOL2
|
Facility
|
OP
|
$71.25
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
3035085B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$17.46
|
| Rate for Payer: Aetna Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.75
|
| Rate for Payer: Cigna Commercial |
$5.39
|
| Rate for Payer: Cigna Medicare Advantage |
$2.69
|
| Rate for Payer: Clover Medicare Advantage |
$5.12
|
| Rate for Payer: EmblemHealth Commercial |
$16.17
|
| Rate for Payer: Humana Medicare Advantage |
$5.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.26
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$5.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.39
|
|
|
CRYPTOSPORODIUM AG, STOOL2
|
Facility
|
IP
|
$71.25
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
3035085B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$10.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.69
|
|
|
CRYSTAL IDENTIFICATION FLUID
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
38477030
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$23.75
|
| Rate for Payer: Aetna Medicare Advantage |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.86
|
| Rate for Payer: Cigna Commercial |
$7.33
|
| Rate for Payer: Cigna Medicare Advantage |
$3.67
|
| Rate for Payer: Clover Medicare Advantage |
$6.96
|
| Rate for Payer: EmblemHealth Commercial |
$21.99
|
| Rate for Payer: Humana Medicare Advantage |
$7.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.17
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.33
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$7.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.33
|
|
|
CRYSTAL IDENTIFICATION FLUID
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
38477030
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.35
|
|
|
CRYSTAL ID (MICRO ANALYSIS)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
3001040
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$23.75
|
| Rate for Payer: Aetna Medicare Advantage |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.86
|
| Rate for Payer: Cigna Commercial |
$7.33
|
| Rate for Payer: Cigna Medicare Advantage |
$3.67
|
| Rate for Payer: Clover Medicare Advantage |
$6.96
|
| Rate for Payer: EmblemHealth Commercial |
$21.99
|
| Rate for Payer: Humana Medicare Advantage |
$7.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.33
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$7.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.33
|
|
|
CRYSTAL ID (MICRO ANALYSIS)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
3001040
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CRYSTALINE NON-BRAIDED HI PRES
|
Facility
|
OP
|
$6.50
|
|
| Hospital Charge Code |
270653898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$1.95
|
| Rate for Payer: Aetna Medicare Advantage |
$1.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.66
|
| Rate for Payer: Cigna Commercial |
$3.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.85
|
| Rate for Payer: Oxford Commercial |
$3.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.25
|
|
|
CRYSTALINE NON-BRAIDED HI PRES
|
Facility
|
IP
|
$6.50
|
|
| Hospital Charge Code |
270653898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.98
|
|
|
CRYSTALS,SYNOVIAL FLUID
|
Facility
|
OP
|
$103.25
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
3001041
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$23.75
|
| Rate for Payer: Aetna Medicare Advantage |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.86
|
| Rate for Payer: Cigna Commercial |
$7.33
|
| Rate for Payer: Cigna Medicare Advantage |
$3.67
|
| Rate for Payer: Clover Medicare Advantage |
$6.96
|
| Rate for Payer: EmblemHealth Commercial |
$21.99
|
| Rate for Payer: Humana Medicare Advantage |
$7.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.42
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.33
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$7.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.33
|
|
|
CRYSTALS,SYNOVIAL FLUID
|
Facility
|
IP
|
$103.25
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
3001041
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.49
|
|
|
CRYSTAL VIOLET STAIN
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
3005256
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
|
|
CRYSTAL VIOLET STAIN
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
3005256
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$316.85 |
| Rate for Payer: Aetna Commercial |
$201.60
|
| Rate for Payer: Aetna Medicare Advantage |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$171.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$171.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$171.36
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$46.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$87.36
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
CRYST NONBRAID HIPRSS CONN L72
|
Facility
|
OP
|
$32.50
|
|
| Hospital Charge Code |
2709003716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$9.75
|
| Rate for Payer: Aetna Medicare Advantage |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.29
|
| Rate for Payer: Cigna Commercial |
$16.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.22
|
| Rate for Payer: Oxford Commercial |
$16.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.25
|
|
|
CRYST NONBRAID HIPRSS CONN L72
|
Facility
|
IP
|
$32.50
|
|
| Hospital Charge Code |
2709003716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.88
|
|