|
ALLERGY,SESAME SEED
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
38479140
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$298.00 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.94
|
| Rate for Payer: Cigna Commercial |
$298.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.22
|
| Rate for Payer: Clover Medicare Advantage |
$4.96
|
| Rate for Payer: EmblemHealth Commercial |
$15.66
|
| Rate for Payer: Humana Medicare Advantage |
$5.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$154.96
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.93
|
|
|
ALLERGY,SHRIMP
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
38479143
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$89.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.40
|
|
|
ALLERGY,SHRIMP
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
38479143
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$298.00 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.94
|
| Rate for Payer: Cigna Commercial |
$298.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.22
|
| Rate for Payer: Clover Medicare Advantage |
$4.96
|
| Rate for Payer: EmblemHealth Commercial |
$15.66
|
| Rate for Payer: Humana Medicare Advantage |
$5.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$154.96
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.93
|
|
|
ALLERGY, SOYBEAN
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
HCPCS 86001
|
| Hospital Charge Code |
38479136
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$298.00 |
| Rate for Payer: Aetna Commercial |
$21.27
|
| Rate for Payer: Aetna Medicare Advantage |
$25.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.37
|
| Rate for Payer: Cigna Commercial |
$298.00
|
| Rate for Payer: Cigna Medicare Advantage |
$7.82
|
| Rate for Payer: Clover Medicare Advantage |
$7.43
|
| Rate for Payer: EmblemHealth Commercial |
$23.46
|
| Rate for Payer: Humana Medicare Advantage |
$8.05
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$154.96
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.93
|
|
|
ALLERGY, SOYBEAN
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
HCPCS 86001
|
| Hospital Charge Code |
38479136
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$89.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.40
|
|
|
ALLERGY,WALNUT
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
38479139
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$298.00 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.94
|
| Rate for Payer: Cigna Commercial |
$298.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.22
|
| Rate for Payer: Clover Medicare Advantage |
$4.96
|
| Rate for Payer: EmblemHealth Commercial |
$15.66
|
| Rate for Payer: Humana Medicare Advantage |
$5.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$154.96
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.93
|
|
|
ALLERGY,WALNUT
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
38479139
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$89.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.40
|
|
|
ALLERGY, WHEAT
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
38479137
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$89.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.40
|
|
|
ALLERGY, WHEAT
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
38479137
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$298.00 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.94
|
| Rate for Payer: Cigna Commercial |
$298.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.22
|
| Rate for Payer: Clover Medicare Advantage |
$4.96
|
| Rate for Payer: EmblemHealth Commercial |
$15.66
|
| Rate for Payer: Humana Medicare Advantage |
$5.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$154.96
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.93
|
|
|
ALLG SPEC IGE CRUDE XTRC EA
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
401086003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.94
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.22
|
| Rate for Payer: Clover Medicare Advantage |
$4.96
|
| Rate for Payer: EmblemHealth Commercial |
$15.66
|
| Rate for Payer: Humana Medicare Advantage |
$5.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
ALLG SPEC IGE CRUDE XTRC EA
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
401086003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ALLOCRAFT GRAFT 6MM-7MM-9MM
|
Facility
|
IP
|
$2,809.00
|
|
| Hospital Charge Code |
270335932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.35 |
| Max. Negotiated Rate |
$679.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$561.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$679.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$421.35
|
|
|
ALLOCRAFT GRAFT 6MM-7MM-9MM
|
Facility
|
OP
|
$2,809.00
|
|
| Hospital Charge Code |
270335932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.78 |
| Max. Negotiated Rate |
$1,404.50 |
| Rate for Payer: Aetna Commercial |
$1,067.42
|
| Rate for Payer: Aetna Medicare Advantage |
$842.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$716.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$716.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$561.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$716.29
|
| Rate for Payer: Cigna Commercial |
$1,404.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$679.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$421.35
|
| Rate for Payer: UnitedHealthcare Community & State |
$88.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.78
|
|
|
ALLODERM 4CM X 7 CM THINK
|
Facility
|
OP
|
$5,215.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270682852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$1,262.03 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$156.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$536.29
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,262.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$782.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$164.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$148.11
|
|
|
ALLODERM 4CM X 7 CM THINK
|
Facility
|
IP
|
$5,215.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270682852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$782.25 |
| Max. Negotiated Rate |
$1,262.03 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,262.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$782.25
|
|
|
ALLODERM 6 CM x12 CM
|
Facility
|
IP
|
$13,535.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270681284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,030.25 |
| Max. Negotiated Rate |
$3,275.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,707.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,275.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,030.25
|
|
|
ALLODERM 6 CM x12 CM
|
Facility
|
OP
|
$13,535.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270681284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$3,275.47 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,707.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$536.29
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,275.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,030.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$427.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$384.39
|
|
|
ALLODERM CONTOUR LARGE 1MM TIC
|
Facility
|
IP
|
$34,095.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270665261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,114.25 |
| Max. Negotiated Rate |
$8,250.99 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,250.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,114.25
|
|
|
ALLODERM CONTOUR LARGE 1MM TIC
|
Facility
|
OP
|
$34,095.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270665261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$8,250.99 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$156.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$536.29
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,250.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,114.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,077.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$968.30
|
|
|
ALLODERM DERMAL GRAFT
|
Facility
|
OP
|
$973.00
|
|
| Hospital Charge Code |
270335499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$486.50 |
| Rate for Payer: Aetna Commercial |
$369.74
|
| Rate for Payer: Aetna Medicare Advantage |
$291.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.12
|
| Rate for Payer: Cigna Commercial |
$486.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.63
|
|
|
ALLODERM DERMAL GRAFT
|
Facility
|
IP
|
$973.00
|
|
| Hospital Charge Code |
270335499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.95 |
| Max. Negotiated Rate |
$235.47 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.95
|
|
|
ALLODERM GRAFT 8X16CM
|
Facility
|
OP
|
$24,450.00
|
|
| Hospital Charge Code |
270339540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$694.38 |
| Max. Negotiated Rate |
$12,225.00 |
| Rate for Payer: Aetna Commercial |
$9,291.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,335.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,234.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,234.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,234.75
|
| Rate for Payer: Cigna Commercial |
$12,225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,916.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,667.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$772.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$694.38
|
|
|
ALLODERM GRAFT 8X16CM
|
Facility
|
IP
|
$24,450.00
|
|
| Hospital Charge Code |
270339540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,667.50 |
| Max. Negotiated Rate |
$5,916.90 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,916.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,667.50
|
|
|
ALLODERM GRAFT 8X16CM/SQ CM JW
|
Facility
|
IP
|
$191.02
|
|
| Hospital Charge Code |
270339540W
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$46.23 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.65
|
|
|
ALLODERM GRAFT 8X16CM/SQ CM JW
|
Facility
|
OP
|
$191.02
|
|
| Hospital Charge Code |
270339540W
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$72.59
|
| Rate for Payer: Aetna Medicare Advantage |
$57.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.71
|
| Rate for Payer: Cigna Commercial |
$95.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.42
|
|
