|
MORPHIX PROCEDURE PACK
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270687493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Oxford Commercial |
$150.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.30
|
|
|
MORPHIX SUTURE ANCHOR
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$940.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.29
|
|
|
MORPHIX SUTURE ANCHOR
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$598.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
MORPHOMETRIC ANALYSIS IHC
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
38474053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$734.21 |
| Rate for Payer: Aetna Commercial |
$550.53
|
| Rate for Payer: Aetna Medicare Advantage |
$655.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$734.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$734.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$734.21
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$202.40
|
| Rate for Payer: Clover Medicare Advantage |
$192.28
|
| Rate for Payer: EmblemHealth Commercial |
$607.20
|
| Rate for Payer: Humana Medicare Advantage |
$208.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$202.40
|
| 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 |
$97.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
MORPHOMETRIC ANALYSIS IHC
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
38474053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
MORPHOMETRIC IN-SITU
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS 88368
|
| Hospital Charge Code |
38474054
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$1,544.73 |
| Rate for Payer: Aetna Commercial |
$1,158.28
|
| Rate for Payer: Aetna Medicare Advantage |
$1,379.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,544.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,544.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$425.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,544.73
|
| Rate for Payer: Cigna Commercial |
$853.60
|
| Rate for Payer: Cigna Medicare Advantage |
$425.84
|
| Rate for Payer: Clover Medicare Advantage |
$404.55
|
| Rate for Payer: EmblemHealth Commercial |
$1,277.52
|
| Rate for Payer: Humana Medicare Advantage |
$438.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$425.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$106.86
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$120.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$425.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$425.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.67
|
|
|
MORPHOMETRIC IN-SITU
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
HCPCS 88368
|
| Hospital Charge Code |
38474054
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$61.65 |
| Max. Negotiated Rate |
$61.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.65
|
|
|
MOT LACTATION SERVICES
|
Facility
|
OP
|
$2,700.00
|
|
| Hospital Charge Code |
93082050
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$76.68 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,026.00
|
| Rate for Payer: Aetna Medicare Advantage |
$810.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$688.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$688.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$688.50
|
| Rate for Payer: Cigna Commercial |
$1,350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$702.00
|
| Rate for Payer: Oxford Commercial |
$1,060.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$405.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,203.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$85.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$76.68
|
|
|
MOT LACTATION SERVICES
|
Facility
|
IP
|
$2,700.00
|
|
| Hospital Charge Code |
93082050
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$405.00
|
|
|
MOTOR SPEECH CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GN
|
| Hospital Charge Code |
9109151
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$933.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
MOTOR SPEECH CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GN
|
| Hospital Charge Code |
9109151
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOTOR SPEECH CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GN
|
| Hospital Charge Code |
84201010
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$933.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
MOTOR SPEECH CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GN
|
| Hospital Charge Code |
84201159
|
|
Hospital Revenue Code
|
449
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOTOR SPEECH CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GN
|
| Hospital Charge Code |
84201010
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOTOR SPEECH CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GN
|
| Hospital Charge Code |
84201159
|
|
Hospital Revenue Code
|
449
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$933.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
Motor Speech Current Status CH
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GNCH
|
| Hospital Charge Code |
74204053CH
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$933.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
Motor Speech Current Status CH
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GNCH
|
| Hospital Charge Code |
74204053CH
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech Current Status CI
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GNCI
|
| Hospital Charge Code |
74204053CI
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$933.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
Motor Speech Current Status CI
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GNCI
|
| Hospital Charge Code |
74204053CI
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech Current Status CJ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GNCJ
|
| Hospital Charge Code |
74204053CJ
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech Current Status CJ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GNCJ
|
| Hospital Charge Code |
74204053CJ
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$933.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
Motor Speech Current Status CK
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GNCK
|
| Hospital Charge Code |
74204053CK
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$933.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
Motor Speech Current Status CK
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GNCK
|
| Hospital Charge Code |
74204053CK
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech Current Status CL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GNCL
|
| Hospital Charge Code |
74204053CL
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech Current Status CL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8999GNCL
|
| Hospital Charge Code |
74204053CL
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$933.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|