|
FETAL NON-STRESS TEST
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
1800077
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
1800077
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Medicare Advantage |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$299.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.75
|
| Rate for Payer: Cigna Commercial |
$481.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.50
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
IP
|
$752.25
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
73190139
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$112.84 |
| Max. Negotiated Rate |
$112.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.84
|
|
|
FETAL SCREEN (K-B)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
38473124
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$25.05
|
| Rate for Payer: Aetna Medicare Advantage |
$7.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.32
|
| Rate for Payer: Cigna Commercial |
$7.73
|
| Rate for Payer: Cigna Medicare Advantage |
$3.87
|
| Rate for Payer: Clover Medicare Advantage |
$7.34
|
| Rate for Payer: EmblemHealth Commercial |
$23.19
|
| Rate for Payer: Humana Medicare Advantage |
$7.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.05
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.73
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$8.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.73
|
|
|
FETAL SCREEN (K-B)
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
38473124
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
|
|
FETAL SCREEN,ROSETTE
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
38476278
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.85
|
|
|
FETAL SCREEN,ROSETTE
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
38476278
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$853.60 |
| Rate for Payer: Aetna Commercial |
$12.41
|
| Rate for Payer: Aetna Medicare Advantage |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.83
|
| 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 |
$14.03
|
| Rate for Payer: Cigna Commercial |
$853.60
|
| Rate for Payer: Cigna Medicare Advantage |
$1.92
|
| Rate for Payer: Clover Medicare Advantage |
$3.64
|
| Rate for Payer: EmblemHealth Commercial |
$11.49
|
| Rate for Payer: Humana Medicare Advantage |
$3.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.87
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.83
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$4.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.83
|
|
|
FETOMATERNAL BLEED FC
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86849
|
| Hospital Charge Code |
397043301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| 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 |
$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
|
|
|
FETOMATERNAL BLEED FC
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86849
|
| Hospital Charge Code |
397043301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
Fetoprotein (AFP), Serum, Tu
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
39888017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$54.33
|
| Rate for Payer: Aetna Medicare Advantage |
$16.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.45
|
| Rate for Payer: Cigna Commercial |
$16.77
|
| Rate for Payer: Cigna Medicare Advantage |
$8.38
|
| Rate for Payer: Clover Medicare Advantage |
$15.93
|
| Rate for Payer: EmblemHealth Commercial |
$50.31
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$86.79
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.77
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$17.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.77
|
|
|
Fetoprotein (AFP), Serum, Tu
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
39888017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$10,636.82
|
|
|
Service Code
|
APR-DRG 7223
|
| Min. Negotiated Rate |
$7,673.17 |
| Max. Negotiated Rate |
$10,636.82 |
| Rate for Payer: Aetna Better Health Medicaid |
$10,428.25
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$10,636.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7,673.17
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$7,627.20
|
|
|
Service Code
|
APR-DRG 7222
|
| Min. Negotiated Rate |
$5,636.19 |
| Max. Negotiated Rate |
$7,627.20 |
| Rate for Payer: Aetna Better Health Medicaid |
$7,477.65
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$7,627.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5,636.19
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$16,244.51
|
|
|
Service Code
|
APR-DRG 7224
|
| Min. Negotiated Rate |
$14,568.87 |
| Max. Negotiated Rate |
$16,244.51 |
| Rate for Payer: Aetna Better Health Medicaid |
$15,925.99
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$16,244.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14,568.87
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$5,361.94
|
|
|
Service Code
|
APR-DRG 7221
|
| Min. Negotiated Rate |
$4,202.63 |
| Max. Negotiated Rate |
$5,361.94 |
| Rate for Payer: Aetna Better Health Medicaid |
$5,256.80
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$5,361.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4,202.63
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$37,588.38
|
|
|
Service Code
|
MSDRG 864
|
| Min. Negotiated Rate |
$9,687.10 |
| Max. Negotiated Rate |
$37,588.38 |
| Rate for Payer: Aetna Commercial |
$29,933.14
|
| Rate for Payer: Aetna Medicare Advantage |
$9,687.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,258.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,258.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12,529.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24,258.96
|
| Rate for Payer: Cigna Commercial |
$19,104.19
|
| Rate for Payer: Cigna Medicare Advantage |
$12,529.46
|
| Rate for Payer: Clover Medicare Advantage |
$11,902.99
|
| Rate for Payer: EmblemHealth Commercial |
$37,588.38
|
| Rate for Payer: Humana Medicare Advantage |
$12,905.34
|
| Rate for Payer: Oxford Commercial |
$11,939.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$13,552.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12,529.46
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$13,281.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$12,529.46
|
|
|
Fexofenadine 180mg
|
Facility
|
OP
|
$6.50
|
|
|
Service Code
|
NDC 3633717
|
| Hospital Charge Code |
6063943281
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Cigna Commercial |
$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: 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
|
|
|
Fexofenadine 180mg
|
Facility
|
IP
|
$6.50
|
|
|
Service Code
|
NDC 3633717
|
| Hospital Charge Code |
6063943281
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.98
|
|
|
FF SEMIT & GRACILLIS TENDON
|
Facility
|
OP
|
$13,375.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
270680655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,006.25 |
| Max. Negotiated Rate |
$6,687.50 |
| Rate for Payer: Aetna Commercial |
$4,012.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,012.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,410.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,410.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,410.62
|
| Rate for Payer: Cigna Commercial |
$6,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,236.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,006.25
|
|
|
FF SEMIT & GRACILLIS TENDON
|
Facility
|
IP
|
$13,375.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
270680655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,006.25 |
| Max. Negotiated Rate |
$3,236.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,675.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,236.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,006.25
|
|
|
FHC DENTAL REFERRAL
|
Facility
|
OP
|
$4,240.00
|
|
| Hospital Charge Code |
9400087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$551.20 |
| Max. Negotiated Rate |
$2,120.00 |
| Rate for Payer: Aetna Commercial |
$1,272.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,272.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,081.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,081.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,081.20
|
| Rate for Payer: Cigna Commercial |
$2,120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$551.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$636.00
|
|
|
FHC DENTAL REFERRAL
|
Facility
|
IP
|
$4,240.00
|
|
| Hospital Charge Code |
9400087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$636.00
|
|
|
FHC DTAP/HEPB/IPV
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
9400094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$50.34 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.20
|
|
|
FHC DTAP/HEPB/IPV
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
9400094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$115.67 |
| Rate for Payer: Aetna Commercial |
$62.40
|
| Rate for Payer: Aetna Medicare Advantage |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.04
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.20
|
|
|
FHC EST PT PREV MED VS 40-64YR
|
Facility
|
OP
|
$281.65
|
|
|
Service Code
|
HCPCS 99396
|
| Hospital Charge Code |
9400028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.61 |
| Max. Negotiated Rate |
$140.82 |
| Rate for Payer: Aetna Commercial |
$84.50
|
| Rate for Payer: Aetna Medicare Advantage |
$84.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.82
|
| Rate for Payer: Cigna Commercial |
$140.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.25
|
|
