|
Antithrombin Activity
|
Facility
|
IP
|
$81.45
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
39888015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$12.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.22
|
|
|
Antithrombin Activity
|
Facility
|
OP
|
$81.45
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
39888015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$32.23
|
| Rate for Payer: Aetna Medicare Advantage |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.99
|
| Rate for Payer: Cigna Commercial |
$40.73
|
| Rate for Payer: Cigna Medicare Advantage |
$11.85
|
| Rate for Payer: Clover Medicare Advantage |
$11.26
|
| Rate for Payer: EmblemHealth Commercial |
$35.55
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.18
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.31
|
|
|
ANTI-THROMBIN III
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
38478056
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$44.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.40
|
|
|
ANTI-THROMBIN III
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
38478056
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$29.40
|
| Rate for Payer: Aetna Medicare Advantage |
$35.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.21
|
| Rate for Payer: Cigna Commercial |
$148.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.81
|
| Rate for Payer: Clover Medicare Advantage |
$10.27
|
| Rate for Payer: EmblemHealth Commercial |
$32.43
|
| Rate for Payer: Humana Medicare Advantage |
$11.13
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.96
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.41
|
|
|
ANTI-THROMBIN III,ACTIVIT
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
39900163
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
ANTI-THROMBIN III,ACTIVIT
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
39900163
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$32.23
|
| Rate for Payer: Aetna Medicare Advantage |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.99
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$11.85
|
| Rate for Payer: Clover Medicare Advantage |
$11.26
|
| Rate for Payer: EmblemHealth Commercial |
$35.55
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.85
|
| 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 |
$9.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
ANTITHROMBIN III ACTIVITY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
401485300
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ANTITHROMBIN III ACTIVITY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
401485300
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$32.23
|
| Rate for Payer: Aetna Medicare Advantage |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.99
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.85
|
| Rate for Payer: Clover Medicare Advantage |
$11.26
|
| Rate for Payer: EmblemHealth Commercial |
$35.55
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.85
|
| 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 |
$9.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
ANTI-THROMBIN III,ANTIGEN
|
Facility
|
IP
|
$74.30
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
39900164
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.14
|
|
|
ANTI-THROMBIN III,ANTIGEN
|
Facility
|
OP
|
$74.30
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
39900164
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$29.40
|
| Rate for Payer: Aetna Medicare Advantage |
$35.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.21
|
| Rate for Payer: Cigna Commercial |
$37.15
|
| Rate for Payer: Cigna Medicare Advantage |
$10.81
|
| Rate for Payer: Clover Medicare Advantage |
$10.27
|
| Rate for Payer: EmblemHealth Commercial |
$32.43
|
| Rate for Payer: Humana Medicare Advantage |
$11.13
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.32
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.11
|
|
|
ANTI-THYROGLOBULIN AB
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
38476010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.45 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
|
|
ANTI-THYROGLOBULIN AB
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
38476010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$261.50 |
| Rate for Payer: Aetna Commercial |
$43.28
|
| Rate for Payer: Aetna Medicare Advantage |
$51.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.71
|
| Rate for Payer: Cigna Commercial |
$261.50
|
| Rate for Payer: Cigna Medicare Advantage |
$15.91
|
| Rate for Payer: Clover Medicare Advantage |
$15.11
|
| Rate for Payer: EmblemHealth Commercial |
$47.73
|
| Rate for Payer: Humana Medicare Advantage |
$16.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.98
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.85
|
|
|
ANTI-THYROGLOBULIN AND MICROSO
|
Facility
|
IP
|
$823.20
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
38476069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$123.48 |
| Max. Negotiated Rate |
$123.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.48
|
|
|
ANTI-THYROGLOBULIN AND MICROSO
|
Facility
|
OP
|
$823.20
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
38476069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$411.60 |
| Rate for Payer: Aetna Commercial |
$39.58
|
| Rate for Payer: Aetna Medicare Advantage |
$47.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.78
|
| Rate for Payer: Cigna Commercial |
$411.60
|
| Rate for Payer: Cigna Medicare Advantage |
$14.55
|
| Rate for Payer: Clover Medicare Advantage |
$13.82
|
| Rate for Payer: EmblemHealth Commercial |
$43.65
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.03
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.38
|
|
|
ANTI-THYROID MICROSOMAL AB
|
Facility
|
IP
|
$823.20
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
38476011
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$123.48 |
| Max. Negotiated Rate |
$123.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.48
|
|
|
ANTI-THYROID MICROSOMAL AB
|
Facility
|
OP
|
$823.20
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
38476011
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$411.60 |
| Rate for Payer: Aetna Commercial |
$39.58
|
| Rate for Payer: Aetna Medicare Advantage |
$47.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.78
|
| Rate for Payer: Cigna Commercial |
$411.60
|
| Rate for Payer: Cigna Medicare Advantage |
$14.55
|
| Rate for Payer: Clover Medicare Advantage |
$13.82
|
| Rate for Payer: EmblemHealth Commercial |
$43.65
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.03
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.38
|
|
|
ANTI YO ANTIBODY
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
38476233
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$49.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
|
|
ANTI YO ANTIBODY
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
38476233
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: Aetna Medicare Advantage |
$58.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.04
|
| Rate for Payer: Cigna Commercial |
$164.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.93
|
| Rate for Payer: Clover Medicare Advantage |
$17.03
|
| Rate for Payer: EmblemHealth Commercial |
$53.79
|
| Rate for Payer: Humana Medicare Advantage |
$18.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.54
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.34
|
|
|
ANT LUM CAGE 10X25X33MMX10D
|
Facility
|
OP
|
$8,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.56 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna Commercial |
$3,192.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,520.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,142.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,142.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,680.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,142.00
|
| Rate for Payer: Cigna Commercial |
$4,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,032.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$265.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$238.56
|
|
|
ANT LUM CAGE 10X25X33MMX10D
|
Facility
|
IP
|
$8,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$2,032.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,680.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,032.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,260.00
|
|
|
ANT LUM CAGE 14X25X33MMX15DEG
|
Facility
|
IP
|
$42,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,300.00 |
| Max. Negotiated Rate |
$10,164.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,164.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,300.00
|
|
|
ANT LUM CAGE 14X25X33MMX15DEG
|
Facility
|
OP
|
$42,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,192.80 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$15,960.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,710.00
|
| Rate for Payer: Cigna Commercial |
$21,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,164.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,327.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,192.80
|
|
|
ANUS SURGERY PROCEDURE
|
Facility
|
IP
|
$3,908.52
|
|
|
Service Code
|
HCPCS 46999
|
| Hospital Charge Code |
1600000588
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$586.28 |
| Max. Negotiated Rate |
$586.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$586.28
|
|
|
ANUS SURGERY PROCEDURE
|
Facility
|
OP
|
$3,908.52
|
|
|
Service Code
|
HCPCS 46999
|
| Hospital Charge Code |
1600000588
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$4,007.70 |
| Rate for Payer: Aetna Commercial |
$3,005.08
|
| Rate for Payer: Aetna Medicare Advantage |
$3,579.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,007.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,007.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,104.81
|
| 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 |
$4,007.70
|
| Rate for Payer: Cigna Commercial |
$2,214.60
|
| Rate for Payer: Cigna Medicare Advantage |
$1,104.81
|
| Rate for Payer: Clover Medicare Advantage |
$1,049.57
|
| Rate for Payer: EmblemHealth Commercial |
$3,314.43
|
| Rate for Payer: Humana Medicare Advantage |
$1,137.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,104.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,016.22
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$586.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$123.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,104.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,104.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$111.00
|
|
|
AO CANNULATED HANDLE
|
Facility
|
IP
|
$705.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.83 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$141.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$170.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.83
|
|
