|
BAR TIBIAL LOCKING
|
Facility
|
OP
|
$1,160.00
|
|
| Hospital Charge Code |
270619033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna Commercial |
$348.00
|
| Rate for Payer: Aetna Medicare Advantage |
$348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$295.80
|
| Rate for Payer: Cigna Commercial |
$580.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$150.80
|
| Rate for Payer: Oxford Commercial |
$580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$174.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$580.00
|
|
|
BAR TIBIAL LOCKING
|
Facility
|
IP
|
$1,160.00
|
|
| Hospital Charge Code |
270619033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$174.00
|
|
|
BAR TO BAR CLAMP
|
Facility
|
OP
|
$540.00
|
|
| Hospital Charge Code |
270339499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Medicare Advantage |
$162.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$137.70
|
| Rate for Payer: Cigna Commercial |
$270.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.20
|
| Rate for Payer: Oxford Commercial |
$270.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$270.00
|
|
|
BAR TO BAR CLAMP
|
Facility
|
IP
|
$540.00
|
|
| Hospital Charge Code |
270339499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.00
|
|
|
BARTONELLA AB(IGG,M)W/RFL I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661191
|
| Hospital Charge Code |
39990083A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BARTONELLA AB(IGG,M)W/RFL I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661191
|
| Hospital Charge Code |
39990083A
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
BARTONELLA AB(IGG,M)W/RFL II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661191
|
| Hospital Charge Code |
39990083B
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
BARTONELLA AB(IGG,M)W/RFL II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661191
|
| Hospital Charge Code |
39990083B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BARTONELLA AB(IGG,M)W/RFL III
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661191
|
| Hospital Charge Code |
39990083C
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
BARTONELLA AB(IGG,M)W/RFL III
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661191
|
| Hospital Charge Code |
39990083C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BARTONELLA AB(IGG,M)W/RFL IV
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661191
|
| Hospital Charge Code |
39990083D
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
BARTONELLA AB(IGG,M)W/RFL IV
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661191
|
| Hospital Charge Code |
39990083D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BARTONELLA ANTIBODY PROFILE I
|
Facility
|
IP
|
$70.65
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3038535D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.60
|
|
|
BARTONELLA ANTIBODY PROFILE I
|
Facility
|
OP
|
$70.65
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3038535D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$32.98
|
| Rate for Payer: Aetna Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.30
|
| Rate for Payer: Cigna Commercial |
$10.18
|
| Rate for Payer: Cigna Medicare Advantage |
$5.09
|
| Rate for Payer: Clover Medicare Advantage |
$9.67
|
| Rate for Payer: EmblemHealth Commercial |
$30.54
|
| Rate for Payer: Humana Medicare Advantage |
$10.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.18
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.18
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$10.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.18
|
|
|
BARTONELLA ANTIBODY PROFILE I
|
Facility
|
IP
|
$70.65
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3038535A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.60
|
|
|
BARTONELLA ANTIBODY PROFILE I
|
Facility
|
OP
|
$70.65
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3038535A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$32.98
|
| Rate for Payer: Aetna Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.30
|
| Rate for Payer: Cigna Commercial |
$10.18
|
| Rate for Payer: Cigna Medicare Advantage |
$5.09
|
| Rate for Payer: Clover Medicare Advantage |
$9.67
|
| Rate for Payer: EmblemHealth Commercial |
$30.54
|
| Rate for Payer: Humana Medicare Advantage |
$10.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.18
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.18
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$10.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.18
|
|
|
BARTONELLA ANTIBODY PROFILE II
|
Facility
|
IP
|
$70.65
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3038535B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.60
|
|
|
BARTONELLA ANTIBODY PROFILE II
|
Facility
|
OP
|
$70.65
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3038535C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$32.98
|
| Rate for Payer: Aetna Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.30
|
| Rate for Payer: Cigna Commercial |
$10.18
|
| Rate for Payer: Cigna Medicare Advantage |
$5.09
|
| Rate for Payer: Clover Medicare Advantage |
$9.67
|
| Rate for Payer: EmblemHealth Commercial |
$30.54
|
| Rate for Payer: Humana Medicare Advantage |
$10.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.18
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.18
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$10.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.18
|
|
|
BARTONELLA ANTIBODY PROFILE II
|
Facility
|
IP
|
$70.65
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3038535C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.60
|
|
|
BARTONELLA ANTIBODY PROFILE II
|
Facility
|
OP
|
$70.65
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3038535B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$32.98
|
| Rate for Payer: Aetna Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.30
|
| Rate for Payer: Cigna Commercial |
$10.18
|
| Rate for Payer: Cigna Medicare Advantage |
$5.09
|
| Rate for Payer: Clover Medicare Advantage |
$9.67
|
| Rate for Payer: EmblemHealth Commercial |
$30.54
|
| Rate for Payer: Humana Medicare Advantage |
$10.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.18
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.18
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$10.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.18
|
|
|
BARTONELLA DNA,PCR
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87471
|
| Hospital Charge Code |
39900291
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$128.57 |
| Rate for Payer: Aetna Commercial |
$113.69
|
| Rate for Payer: Aetna Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$128.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$128.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$37.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$128.57
|
| Rate for Payer: Cigna Commercial |
$35.09
|
| Rate for Payer: Cigna Medicare Advantage |
$17.55
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| 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 |
$35.09
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$37.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
BARTONELLA DNA,PCR
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87471
|
| Hospital Charge Code |
39900291
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BARTONELLA, DNA PCR
|
Facility
|
OP
|
$241.20
|
|
|
Service Code
|
HCPCS 87471
|
| Hospital Charge Code |
3038095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$128.57 |
| Rate for Payer: Aetna Commercial |
$113.69
|
| Rate for Payer: Aetna Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$128.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$128.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$37.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$128.57
|
| Rate for Payer: Cigna Commercial |
$35.09
|
| Rate for Payer: Cigna Medicare Advantage |
$17.55
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.36
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$37.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
BARTONELLA, DNA PCR
|
Facility
|
IP
|
$241.20
|
|
|
Service Code
|
HCPCS 87471
|
| Hospital Charge Code |
3038095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.18 |
| Max. Negotiated Rate |
$36.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.18
|
|
|
BASALJEL/400MG/5ML
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
60632531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.20
|
|