|
PANEL 1
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
39708028A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$82.46
|
| Rate for Payer: Aetna Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$26.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.25
|
| Rate for Payer: Cigna Commercial |
$25.45
|
| Rate for Payer: Cigna Medicare Advantage |
$12.72
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| 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 |
$25.45
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$26.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
|
|
PANEL 2
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
39708028B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 2
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
39708028B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$82.46
|
| Rate for Payer: Aetna Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$26.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.25
|
| Rate for Payer: Cigna Commercial |
$25.45
|
| Rate for Payer: Cigna Medicare Advantage |
$12.72
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| 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 |
$25.45
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$26.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
|
|
PANEL 3
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
366886146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$82.46
|
| Rate for Payer: Aetna Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$26.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.25
|
| Rate for Payer: Cigna Commercial |
$25.45
|
| Rate for Payer: Cigna Medicare Advantage |
$12.72
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| 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 |
$25.45
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$26.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
|
|
PANEL 3
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
39708028C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$82.46
|
| Rate for Payer: Aetna Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$26.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.25
|
| Rate for Payer: Cigna Commercial |
$25.45
|
| Rate for Payer: Cigna Medicare Advantage |
$12.72
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| 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 |
$25.45
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$26.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
|
|
PANEL 3
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
366886146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
PANEL 3
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
39708028C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 4
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
39708028D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 4
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
39708028D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$82.46
|
| Rate for Payer: Aetna Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.25
|
| Rate for Payer: Cigna Commercial |
$25.45
|
| Rate for Payer: Cigna Medicare Advantage |
$12.72
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| 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 |
$25.45
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$26.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
|
|
PANEL 5
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
39708028E
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$82.46
|
| Rate for Payer: Aetna Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.25
|
| Rate for Payer: Cigna Commercial |
$25.45
|
| Rate for Payer: Cigna Medicare Advantage |
$12.72
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| 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 |
$25.45
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$26.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
|
|
PANEL 5
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
39708028E
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 6
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
39708028F
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 6
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
39708028F
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$82.46
|
| Rate for Payer: Aetna Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.25
|
| Rate for Payer: Cigna Commercial |
$25.45
|
| Rate for Payer: Cigna Medicare Advantage |
$12.72
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| 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 |
$25.45
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$26.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
|
|
PANEL 7
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
39708028G
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$52.07
|
| Rate for Payer: Aetna Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.88
|
| Rate for Payer: Cigna Commercial |
$16.07
|
| Rate for Payer: Cigna Medicare Advantage |
$8.04
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| 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 |
$16.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
|
|
PANEL 7
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
39708028G
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 8
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
39708028H
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 8
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
39708028H
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$52.07
|
| Rate for Payer: Aetna Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.88
|
| Rate for Payer: Cigna Commercial |
$16.07
|
| Rate for Payer: Cigna Medicare Advantage |
$8.04
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| 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 |
$16.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
|
|
PANEL 9
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
39708028I
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 9
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
366886148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
PANEL 9
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
39708028I
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$52.07
|
| Rate for Payer: Aetna Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.88
|
| Rate for Payer: Cigna Commercial |
$16.07
|
| Rate for Payer: Cigna Medicare Advantage |
$8.04
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| 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 |
$16.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
|
|
PANEL 9
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
366886148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$52.07
|
| Rate for Payer: Aetna Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.88
|
| Rate for Payer: Cigna Commercial |
$16.07
|
| Rate for Payer: Cigna Medicare Advantage |
$8.04
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| 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 |
$16.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
|
|
Panel, Gastrointestinal
|
Facility
|
IP
|
$545.40
|
|
|
Service Code
|
HCPCS 38470
|
| Hospital Charge Code |
3000077
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$81.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.81
|
|
|
Panel, Gastrointestinal
|
Facility
|
OP
|
$545.40
|
|
|
Service Code
|
HCPCS 38470
|
| Hospital Charge Code |
3000077
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.90 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Aetna Commercial |
$163.62
|
| Rate for Payer: Aetna Medicare Advantage |
$163.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$139.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$139.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$139.08
|
| Rate for Payer: Cigna Commercial |
$272.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
PANEL MENINGOENCEPHALITIS
|
Facility
|
OP
|
$2,136.90
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
399900536
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$320.54 |
| Rate for Payer: Aetna Commercial |
$42.74
|
| Rate for Payer: Aetna Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.33
|
| Rate for Payer: Cigna Commercial |
$13.19
|
| Rate for Payer: Cigna Medicare Advantage |
$6.59
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$277.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$320.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$13.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
|
|
PANEL MENINGOENCEPHALITIS
|
Facility
|
IP
|
$2,136.90
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
399900536
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$320.54 |
| Max. Negotiated Rate |
$320.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$320.54
|
|
