|
IND PSYTX NONMD CH/30M PH CAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822626
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYTX NONMD CH/30M PH CAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822626
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$764.93 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.30
|
|
|
IND PSYTX NONMD CH/30M PH CAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4509626
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$764.93 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.30
|
|
|
IND PSYTX NONMD CH/30M PH CAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4510626
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYTX NONMD CH/30M PH CAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4510626
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$764.93 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.30
|
|
|
IND PSYTX NONMD CH/30M PH CAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4824626
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYTX NONMD CH/30M PH CAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4824626
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$764.93 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.30
|
|
|
IND PTX NONMD AD/30MIN PH CAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4509620
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$764.93 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.30
|
|
|
IND PTX NONMD AD/30MIN PH CAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822620
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$764.93 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.30
|
|
|
IND PTX NONMD AD/30MIN PH CAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4509620
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PTX NONMD AD/30MIN PH CAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822620
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND SESSION NON MD 30 MIN
|
Facility
|
IP
|
$1,296.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
87506100
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.40
|
|
|
IND SESSION NON MD 30 MIN
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
87506100
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$764.93 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$336.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$40.95
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.81
|
|
|
IND SESSION NON MD 45 MIN
|
Facility
|
OP
|
$1,423.80
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
87506105
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$764.93 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$370.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.57
|
| Rate for Payer: UnitedHealthcare Community & State |
$44.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.44
|
|
|
IND SESSION NON MD 45 MIN
|
Facility
|
IP
|
$1,423.80
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
87506105
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$213.57 |
| Max. Negotiated Rate |
$213.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.57
|
|
|
IND SESSION NON MD 60 MIN
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
87506110
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$764.93 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$108.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
IND SESSION NON MD 60 MIN
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
87506110
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
IND. THERAPY 75-80 MN
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
HCPCS 90808
|
| Hospital Charge Code |
84504030
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$100.65 |
| Max. Negotiated Rate |
$100.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.65
|
|
|
IND. THERAPY 75-80 MN
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS 90808
|
| Hospital Charge Code |
84504030
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$335.50 |
| Rate for Payer: Aetna Commercial |
$254.98
|
| Rate for Payer: Aetna Medicare Advantage |
$201.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$171.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$171.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$171.10
|
| Rate for Payer: Cigna Commercial |
$335.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.06
|
|
|
INDUCED ABORTION BY D & C
|
Facility
|
IP
|
$19,400.60
|
|
|
Service Code
|
HCPCS 59840
|
| Hospital Charge Code |
1600000826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,910.09 |
| Max. Negotiated Rate |
$2,910.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,910.09
|
|
|
INDUCED ABORTION BY D & C
|
Facility
|
OP
|
$19,400.60
|
|
|
Service Code
|
HCPCS 59840
|
| Hospital Charge Code |
1600000826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$550.98 |
| Max. Negotiated Rate |
$13,950.60 |
| Rate for Payer: Aetna Commercial |
$10,460.55
|
| Rate for Payer: Aetna Medicare Advantage |
$12,460.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,950.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,950.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,845.79
|
| 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 |
$13,950.60
|
| Rate for Payer: Cigna Commercial |
$7,708.87
|
| Rate for Payer: Cigna Medicare Advantage |
$3,845.79
|
| Rate for Payer: Clover Medicare Advantage |
$3,653.50
|
| Rate for Payer: EmblemHealth Commercial |
$11,537.37
|
| Rate for Payer: Humana Medicare Advantage |
$3,961.16
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,845.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,044.16
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,910.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$613.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,845.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,845.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$550.98
|
|
|
INF AGENT DETECT AMP PROB TECH
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
38476308
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.05
|
|
|
INF AGENT DETECT AMP PROB TECH
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
38476308
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.29
|
| 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 |
$130.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.29
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cigna Medicare Advantage |
$35.09
|
| 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: Longevity Health Plan of New Jersey Medicare Advantage |
$35.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.22
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.01
|
|
|
INF CONCONURRENT THERAPEUTIC
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
395096368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
INF CONCONURRENT THERAPEUTIC
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
395096368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,064.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$728.00
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$88.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.52
|
|
