|
GFRG AUTOL FAT LIPO EA ADDL
|
Facility
|
OP
|
$8,265.00
|
|
|
Service Code
|
HCPCS 15774
|
| Hospital Charge Code |
1600000627
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$234.73 |
| Max. Negotiated Rate |
$4,132.50 |
| Rate for Payer: Aetna Commercial |
$3,140.70
|
| Rate for Payer: Aetna Medicare Advantage |
$2,479.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,107.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,107.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,107.57
|
| Rate for Payer: Cigna Commercial |
$4,132.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,148.90
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,239.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$261.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$234.73
|
|
|
GGTP GAMMA GLUTAMYLTRANSFERAS
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
3030293
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
GGTP GAMMA GLUTAMYLTRANSFERAS
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
3030293
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Medicare Advantage |
$23.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.12
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$7.20
|
| Rate for Payer: Clover Medicare Advantage |
$6.84
|
| Rate for Payer: EmblemHealth Commercial |
$21.60
|
| Rate for Payer: Humana Medicare Advantage |
$7.42
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.57
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
GIARDIA AG EIA,STOOL
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS 87328
|
| Hospital Charge Code |
38479086
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$26.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.70
|
|
|
GIARDIA AG EIA,STOOL
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS 87328
|
| Hospital Charge Code |
38479086
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$37.59
|
| Rate for Payer: Aetna Medicare Advantage |
$44.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$50.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$50.13
|
| 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 |
$12.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$50.13
|
| Rate for Payer: Cigna Commercial |
$89.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.82
|
| 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: Longevity Health Plan of New Jersey Medicare Advantage |
$13.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.28
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.06
|
|
|
GIARDIA AG,EIA,STOOL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87329
|
| Hospital Charge Code |
39990054EX
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Medicare Advantage |
$38.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.46
|
| 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 |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.46
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.98
|
| 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: Longevity Health Plan of New Jersey Medicare Advantage |
$11.98
|
| 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 |
$9.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
GIARDIA AG,EIA,STOOL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87329
|
| Hospital Charge Code |
39990054EX
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
GIARDIA AG,EIA,STOOL, I
|
Facility
|
IP
|
$75.65
|
|
|
Service Code
|
HCPCS 87328
|
| Hospital Charge Code |
39990054A
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$11.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.35
|
|
|
GIARDIA AG,EIA,STOOL, I
|
Facility
|
OP
|
$75.65
|
|
|
Service Code
|
HCPCS 87328
|
| Hospital Charge Code |
39990054A
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$37.59
|
| Rate for Payer: Aetna Medicare Advantage |
$44.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$50.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$50.13
|
| 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 |
$12.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$50.13
|
| Rate for Payer: Cigna Commercial |
$37.83
|
| Rate for Payer: Cigna Medicare Advantage |
$13.82
|
| 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: Longevity Health Plan of New Jersey Medicare Advantage |
$13.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.67
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
GIARDIA AG,EIA,STOOL, II
|
Facility
|
OP
|
$75.65
|
|
|
Service Code
|
HCPCS 87329
|
| Hospital Charge Code |
39990054B
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Medicare Advantage |
$38.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.46
|
| 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 |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.46
|
| Rate for Payer: Cigna Commercial |
$37.83
|
| Rate for Payer: Cigna Medicare Advantage |
$11.98
|
| 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: Longevity Health Plan of New Jersey Medicare Advantage |
$11.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.67
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
GIARDIA AG,EIA,STOOL, II
|
Facility
|
IP
|
$75.65
|
|
|
Service Code
|
HCPCS 87329
|
| Hospital Charge Code |
39990054B
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$11.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.35
|
|
|
GIEMSA STAIN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
3005267
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$224.58 |
| Rate for Payer: Aetna Commercial |
$168.40
|
| Rate for Payer: Aetna Medicare Advantage |
$200.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$61.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$224.58
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: Cigna Medicare Advantage |
$61.91
|
| Rate for Payer: Clover Medicare Advantage |
$58.81
|
| Rate for Payer: EmblemHealth Commercial |
$185.73
|
| Rate for Payer: Humana Medicare Advantage |
$63.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$61.91
|
| 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 |
$92.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
GIEMSA STAIN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
3005267
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
GI PATHOGEN PANEL RT-PCR STOOL
|
Facility
|
OP
|
$495.82
|
|
|
Service Code
|
HCPCS 87506
|
| Hospital Charge Code |
401387506
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$954.00 |
| Rate for Payer: Aetna Commercial |
$715.33
|
| Rate for Payer: Aetna Medicare Advantage |
$852.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$954.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$954.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$262.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$191.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$954.00
|
| Rate for Payer: Cigna Commercial |
$247.91
|
| Rate for Payer: Cigna Medicare Advantage |
$262.99
|
| Rate for Payer: Clover Medicare Advantage |
$249.84
|
| Rate for Payer: EmblemHealth Commercial |
$788.97
|
| Rate for Payer: Humana Medicare Advantage |
$270.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$262.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.91
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$210.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$262.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$262.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.08
|
|
|
GI PATHOGEN PANEL RT-PCR STOOL
|
Facility
|
IP
|
$495.82
|
|
|
Service Code
|
HCPCS 87506
|
| Hospital Charge Code |
401387506
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.37 |
| Max. Negotiated Rate |
$74.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.37
|
|
|
GI STOOL PCR PANEL 22TARGETS
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 0097U
|
| Hospital Charge Code |
40130097U
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$296.40
|
| Rate for Payer: Aetna Medicare Advantage |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$198.90
|
| Rate for Payer: Cigna Commercial |
$390.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$202.80
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$117.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.15
|
|
|
GI STOOL PCR PANEL 22TARGETS
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 0097U
|
| Hospital Charge Code |
40130097U
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$117.00
|
|
|
GLDW .035 260CM S ANGL GS350
|
Facility
|
IP
|
$281.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270637622C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.23 |
| Max. Negotiated Rate |
$68.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$68.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.23
|
|
|
GLDW .035 260CM S ANGL GS350
|
Facility
|
OP
|
$281.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270637622C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$106.97
|
| Rate for Payer: Aetna Medicare Advantage |
$84.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.78
|
| Rate for Payer: Cigna Commercial |
$140.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$68.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.23
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.99
|
|
|
GLDW .035 260CM S ANGL GS350
|
Facility
|
IP
|
$306.10
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270637622N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.91 |
| Max. Negotiated Rate |
$74.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$74.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.91
|
|
|
GLDW .035 260CM S ANGL GS350
|
Facility
|
OP
|
$306.10
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270637622N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$153.05 |
| Rate for Payer: Aetna Commercial |
$116.32
|
| Rate for Payer: Aetna Medicare Advantage |
$91.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.06
|
| Rate for Payer: Cigna Commercial |
$153.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$74.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.91
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.69
|
|
|
GLENIOD CAGE BETA LARGE
|
Facility
|
OP
|
$7,405.00
|
|
| Hospital Charge Code |
270675723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.30 |
| Max. Negotiated Rate |
$3,702.50 |
| Rate for Payer: Aetna Commercial |
$2,813.90
|
| Rate for Payer: Aetna Medicare Advantage |
$2,221.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,888.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,888.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,481.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,888.28
|
| Rate for Payer: Cigna Commercial |
$3,702.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,792.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,110.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$234.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$210.30
|
|
|
GLENIOD CAGE BETA LARGE
|
Facility
|
IP
|
$7,405.00
|
|
| Hospital Charge Code |
270675723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.75 |
| Max. Negotiated Rate |
$1,792.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,481.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,792.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,110.75
|
|
|
GLENIOD CAGE BETA MEDIUM
|
Facility
|
OP
|
$7,405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.30 |
| Max. Negotiated Rate |
$3,702.50 |
| Rate for Payer: Aetna Commercial |
$2,813.90
|
| Rate for Payer: Aetna Medicare Advantage |
$2,221.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,888.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,888.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,481.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,888.28
|
| Rate for Payer: Cigna Commercial |
$3,702.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,792.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,110.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$234.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$210.30
|
|
|
GLENIOD CAGE BETA MEDIUM
|
Facility
|
IP
|
$7,405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.75 |
| Max. Negotiated Rate |
$1,792.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,481.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,792.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,110.75
|
|
