|
L VENTRIC PACING LEAD ADD ON
|
Facility
|
IP
|
$27,941.00
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
411033225
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,191.15 |
| Max. Negotiated Rate |
$4,191.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,191.15
|
|
|
LYME AB IGG, IGM IFA CSF I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661891
|
| Hospital Charge Code |
39990086A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.45
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| 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 |
$12.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
LYME AB IGG, IGM IFA CSF I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661891
|
| Hospital Charge Code |
39990086A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYME AB IGG, IGM IFA CSF II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661891
|
| Hospital Charge Code |
39990086B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYME AB IGG, IGM IFA CSF II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661891
|
| Hospital Charge Code |
39990086B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.45
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| 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 |
$12.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
LYME ANTIBODIES, IgM, QUANT
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
38476189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.78
|
| Rate for Payer: Cigna Commercial |
$214.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$111.54
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.18
|
|
|
LYME ANTIBODIES, IgM, QUANT
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
38476189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.35
|
|
|
LYME ANTIBODIES, QUANT
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
38476186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.30 |
| Max. Negotiated Rate |
$81.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.30
|
|
|
LYME ANTIBODIES, QUANT
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
38476186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.78
|
| Rate for Payer: Cigna Commercial |
$271.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$140.92
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.39
|
|
|
LYME CONFIRMATION TEST
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
38476266
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$42.13
|
| Rate for Payer: Aetna Medicare Advantage |
$50.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.19
|
| Rate for Payer: Cigna Commercial |
$95.00
|
| Rate for Payer: Cigna Medicare Advantage |
$15.49
|
| Rate for Payer: Clover Medicare Advantage |
$14.72
|
| Rate for Payer: EmblemHealth Commercial |
$46.47
|
| Rate for Payer: Humana Medicare Advantage |
$15.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.40
|
|
|
LYME CONFIRMATION TEST
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
38476266
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.50
|
|
|
LYME DISEASE(B.SPP)DNA,SF
|
Facility
|
OP
|
$825.84
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
39900307
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$412.92 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: Aetna Medicare Advantage |
$227.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$254.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$254.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$65.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$254.65
|
| Rate for Payer: Cigna Commercial |
$412.92
|
| Rate for Payer: Cigna Medicare Advantage |
$70.20
|
| Rate for Payer: Clover Medicare Advantage |
$66.69
|
| Rate for Payer: EmblemHealth Commercial |
$210.60
|
| Rate for Payer: Humana Medicare Advantage |
$72.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$70.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.72
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$56.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.45
|
|
|
LYME DISEASE(B.SPP)DNA,SF
|
Facility
|
IP
|
$825.84
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
39900307
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$123.88 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.88
|
|
|
Lyme Disease, Total Antibody T
|
Facility
|
OP
|
$117.05
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
39888013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.78
|
| Rate for Payer: Cigna Commercial |
$58.52
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.43
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.32
|
|
|
Lyme Disease, Total Antibody T
|
Facility
|
IP
|
$117.05
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
39888013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.56
|
|
|
LYME DISEASE WITH REFLEX TO WE
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
39900370
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
LYME DISEASE WITH REFLEX TO WE
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
39900370
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.78
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| 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 |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
LYMPHANGIOGRAPHY EXTREM BILAT
|
Facility
|
IP
|
$2,417.00
|
|
|
Service Code
|
HCPCS 75803
|
| Hospital Charge Code |
7411705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$362.55 |
| Max. Negotiated Rate |
$362.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$362.55
|
|
|
LYMPHANGIOGRAPHY EXTREM BILAT
|
Facility
|
OP
|
$2,417.00
|
|
|
Service Code
|
HCPCS 75803
|
| Hospital Charge Code |
2680340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$6,783.93 |
| Rate for Payer: Aetna Commercial |
$5,086.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6,059.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,870.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$179.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,783.93
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,309.10
|
| Rate for Payer: Clover Medicare Advantage |
$1,776.63
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,926.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,870.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$628.42
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$362.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$76.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$68.64
|
|
|
LYMPHANGIOGRAPHY EXTREM BILAT
|
Facility
|
IP
|
$2,417.00
|
|
|
Service Code
|
HCPCS 75803
|
| Hospital Charge Code |
2680340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$362.55 |
| Max. Negotiated Rate |
$362.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$362.55
|
|
|
LYMPHANGIOGRAPHY EXTREM BILAT
|
Facility
|
OP
|
$2,417.00
|
|
|
Service Code
|
HCPCS 75803
|
| Hospital Charge Code |
7411705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$6,783.93 |
| Rate for Payer: Aetna Commercial |
$5,086.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6,059.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,870.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$179.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,783.93
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,309.10
|
| Rate for Payer: Clover Medicare Advantage |
$1,776.63
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,926.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,870.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$628.42
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$362.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$76.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$68.64
|
|
|
LYMPHANGIOGRAPHY EXT UNIL RSI
|
Facility
|
OP
|
$2,417.00
|
|
|
Service Code
|
HCPCS 75801
|
| Hospital Charge Code |
7411704
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$2,703.39 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$119.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,703.39
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$521.67
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$628.42
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$362.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$76.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$68.64
|
|
|
LYMPHANGIOGRAPHY EXT UNIL RSI
|
Facility
|
OP
|
$2,417.00
|
|
|
Service Code
|
HCPCS 75801
|
| Hospital Charge Code |
2680335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$2,703.39 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$119.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,703.39
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$521.67
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$628.42
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$362.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$76.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$68.64
|
|
|
LYMPHANGIOGRAPHY EXT UNIL RSI
|
Facility
|
IP
|
$2,417.00
|
|
|
Service Code
|
HCPCS 75801
|
| Hospital Charge Code |
7411704
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$362.55 |
| Max. Negotiated Rate |
$362.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$362.55
|
|
|
LYMPHANGIOGRAPHY EXT UNIL RSI
|
Facility
|
IP
|
$2,417.00
|
|
|
Service Code
|
HCPCS 75801
|
| Hospital Charge Code |
2680335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$362.55 |
| Max. Negotiated Rate |
$362.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$362.55
|
|
