|
IGF BINDING PROTEIN 2
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
39900437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Aetna Medicare Advantage |
$59.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.75
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.40
|
| Rate for Payer: Clover Medicare Advantage |
$17.48
|
| Rate for Payer: EmblemHealth Commercial |
$55.20
|
| Rate for Payer: Humana Medicare Advantage |
$18.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.40
|
| 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 |
$14.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
IGF BINDING PROTEIN 2
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
39900437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
IGF BINDING PROTEIN-3
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
39900335
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Aetna Medicare Advantage |
$59.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.75
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.40
|
| Rate for Payer: Clover Medicare Advantage |
$17.48
|
| Rate for Payer: EmblemHealth Commercial |
$55.20
|
| Rate for Payer: Humana Medicare Advantage |
$18.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.40
|
| 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 |
$14.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
IGF BINDING PROTEIN-3
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
39900335
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
IGF II
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
38472938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Aetna Medicare Advantage |
$59.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.75
|
| Rate for Payer: Cigna Commercial |
$47.50
|
| Rate for Payer: Cigna Medicare Advantage |
$18.40
|
| Rate for Payer: Clover Medicare Advantage |
$17.48
|
| Rate for Payer: EmblemHealth Commercial |
$55.20
|
| Rate for Payer: Humana Medicare Advantage |
$18.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.70
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.70
|
|
|
IGF II
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
38472938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.25
|
|
|
IGF-II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
39900435
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Aetna Medicare Advantage |
$59.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.75
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.40
|
| Rate for Payer: Clover Medicare Advantage |
$17.48
|
| Rate for Payer: EmblemHealth Commercial |
$55.20
|
| Rate for Payer: Humana Medicare Advantage |
$18.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.40
|
| 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 |
$14.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
IGF-II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
39900435
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
IgG
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38472410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.74
|
| Rate for Payer: Cigna Commercial |
$103.50
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.82
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.88
|
|
|
IgG
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38472410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
|
|
IGG
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38479448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.74
|
| Rate for Payer: Cigna Commercial |
$103.50
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.82
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.88
|
|
|
IGG
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38479416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.74
|
| Rate for Payer: Cigna Commercial |
$103.50
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.82
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.88
|
|
|
IGG
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38479448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
|
|
IGG
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38479416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
|
|
IGG, CSF
|
Facility
|
IP
|
$63.90
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
39900082
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.59
|
|
|
IGG, CSF
|
Facility
|
OP
|
$63.90
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
39900082
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.74
|
| Rate for Payer: Cigna Commercial |
$31.95
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.61
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.81
|
|
|
IGG,CSF
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38479078
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
|
|
IGG,CSF
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
38479078
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.74
|
| Rate for Payer: Cigna Commercial |
$103.50
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.82
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.88
|
|
|
IGG INDEX AND SYNTHESIS RATE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
39990147A
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$13.46
|
| Rate for Payer: Aetna Medicare Advantage |
$16.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.96
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.95
|
| Rate for Payer: Clover Medicare Advantage |
$4.70
|
| Rate for Payer: EmblemHealth Commercial |
$14.85
|
| Rate for Payer: Humana Medicare Advantage |
$5.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.95
|
| 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 |
$3.96
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
IGG INDEX AND SYNTHESIS RATE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
39990147A
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
IGG INDEX AND SYNTHESIS RATE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
39990147C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
IGG INDEX AND SYNTHESIS RATE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
39990147B
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare Advantage |
$25.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.22
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$7.78
|
| Rate for Payer: Clover Medicare Advantage |
$7.39
|
| Rate for Payer: EmblemHealth Commercial |
$23.34
|
| Rate for Payer: Humana Medicare Advantage |
$8.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.78
|
| 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 |
$6.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
IGG INDEX AND SYNTHESIS RATE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
39990147B
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
IGG INDEX AND SYNTHESIS RATE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
39990147C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.74
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$9.30
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.30
|
| 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 |
$7.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
IGG INDEX AND SYNTHESIS RATE I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
39990147D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
