|
NAVIFLEX RX DELIVERY SYSTM 7FR
|
Facility
|
IP
|
$405.90
|
|
| Hospital Charge Code |
270659227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.88 |
| Max. Negotiated Rate |
$60.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.88
|
|
|
NAVIGATION LANTERN ASSIST DEV
|
Facility
|
IP
|
$6,000.00
|
|
| Hospital Charge Code |
270694804
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
NAVIGATION LANTERN ASSIST DEV
|
Facility
|
OP
|
$6,000.00
|
|
| Hospital Charge Code |
270694804
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,280.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,530.00
|
| Rate for Payer: Cigna Commercial |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,560.00
|
| Rate for Payer: Oxford Commercial |
$1,200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,200.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$189.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$170.40
|
|
|
NAVIGATOR CANNULA LEFT MID
|
Facility
|
OP
|
$1,075.00
|
|
| Hospital Charge Code |
270691762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$537.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Medicare Advantage |
$322.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$274.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$274.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$274.12
|
| Rate for Payer: Cigna Commercial |
$537.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$279.50
|
| Rate for Payer: Oxford Commercial |
$215.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$215.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.53
|
|
|
NAVIGATOR CANNULA LEFT MID
|
Facility
|
IP
|
$1,075.00
|
|
| Hospital Charge Code |
270691762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.25 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.25
|
|
|
NAVIGATOR POST RIGHT
|
Facility
|
IP
|
$1,075.00
|
|
| Hospital Charge Code |
270691763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.25 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.25
|
|
|
NAVIGATOR POST RIGHT
|
Facility
|
OP
|
$1,075.00
|
|
| Hospital Charge Code |
270691763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$537.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Medicare Advantage |
$322.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$274.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$274.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$274.12
|
| Rate for Payer: Cigna Commercial |
$537.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$279.50
|
| Rate for Payer: Oxford Commercial |
$215.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$215.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.53
|
|
|
NAV-X BLADE
|
Facility
|
OP
|
$3,540.00
|
|
| Hospital Charge Code |
270679505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.54 |
| Max. Negotiated Rate |
$1,770.00 |
| Rate for Payer: Aetna Commercial |
$1,345.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1,062.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$902.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$902.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$902.70
|
| Rate for Payer: Cigna Commercial |
$1,770.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$920.40
|
| Rate for Payer: Oxford Commercial |
$708.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$531.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$708.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$111.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$100.54
|
|
|
NAV-X BLADE
|
Facility
|
IP
|
$3,540.00
|
|
| Hospital Charge Code |
270679505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.00 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$531.00
|
|
|
N BLOCK INJ CELIAC PELUS
|
Facility
|
OP
|
$3,583.05
|
|
|
Service Code
|
HCPCS 64530
|
| Hospital Charge Code |
16001042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$101.76 |
| Max. Negotiated Rate |
$3,811.70 |
| Rate for Payer: Aetna Commercial |
$2,858.12
|
| Rate for Payer: Aetna Medicare Advantage |
$3,404.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,811.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,811.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,050.78
|
| 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 |
$3,811.70
|
| Rate for Payer: Cigna Commercial |
$2,106.27
|
| Rate for Payer: Cigna Medicare Advantage |
$1,050.78
|
| Rate for Payer: Clover Medicare Advantage |
$998.24
|
| Rate for Payer: EmblemHealth Commercial |
$3,152.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,082.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,050.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$931.59
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$537.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$113.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,050.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,050.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$101.76
|
|
|
N BLOCK INJ CELIAC PELUS
|
Facility
|
IP
|
$3,583.05
|
|
|
Service Code
|
HCPCS 64530
|
| Hospital Charge Code |
16001042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.46 |
| Max. Negotiated Rate |
$537.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$537.46
|
|
|
N BLOCK INJ FACIAL
|
Facility
|
IP
|
$615.85
|
|
|
Service Code
|
HCPCS 64402
|
| Hospital Charge Code |
412364402
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.38 |
| Max. Negotiated Rate |
$92.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.38
|
|
|
N BLOCK INJ FACIAL
|
Facility
|
OP
|
$615.85
|
|
|
Service Code
|
HCPCS 64402
|
| Hospital Charge Code |
412364402
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$307.93 |
| Rate for Payer: Aetna Commercial |
$234.02
|
| Rate for Payer: Aetna Medicare Advantage |
$184.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$157.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$157.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$157.04
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.49
|
|
|
N BLOCK INJ HYPOGAS PLXS
|
Facility
|
OP
|
$5,242.30
|
|
|
Service Code
|
HCPCS 64517
|
| Hospital Charge Code |
1600000410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.88 |
| Max. Negotiated Rate |
$3,811.70 |
| Rate for Payer: Aetna Commercial |
$2,858.12
|
| Rate for Payer: Aetna Medicare Advantage |
$3,404.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,811.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,811.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,050.78
|
| 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 |
$3,811.70
|
| Rate for Payer: Cigna Commercial |
$2,106.27
|
| Rate for Payer: Cigna Medicare Advantage |
$1,050.78
|
| Rate for Payer: Clover Medicare Advantage |
$998.24
|
| Rate for Payer: EmblemHealth Commercial |
$3,152.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,082.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,050.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,363.00
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$786.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$165.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,050.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,050.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$148.88
|
|
|
N BLOCK INJ HYPOGAS PLXS
|
Facility
|
IP
|
$5,242.30
|
|
|
Service Code
|
HCPCS 64517
|
| Hospital Charge Code |
1600000410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$786.35 |
| Max. Negotiated Rate |
$786.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$786.35
|
|
|
N BLOCK INJ INTERCOST SNG
|
Facility
|
OP
|
$4,204.50
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
1600000850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$119.41 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,281.02
|
| Rate for Payer: Aetna Medicare Advantage |
$2,717.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,042.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,042.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$838.61
|
| 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 |
$3,042.06
|
| Rate for Payer: Cigna Commercial |
$1,680.99
|
| Rate for Payer: Cigna Medicare Advantage |
$838.61
|
| Rate for Payer: Clover Medicare Advantage |
$796.68
|
| Rate for Payer: EmblemHealth Commercial |
$2,515.83
|
| Rate for Payer: Humana Medicare Advantage |
$863.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$838.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,093.17
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$630.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$132.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$119.41
|
|
|
N BLOCK INJ INTERCOST SNG
|
Facility
|
IP
|
$4,204.50
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
1600000850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$630.67 |
| Max. Negotiated Rate |
$630.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$630.67
|
|
|
N BLOCK INJ OCCIPITAL
|
Facility
|
IP
|
$717.30
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
412364405
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.59 |
| Max. Negotiated Rate |
$107.59 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.59
|
|
|
N BLOCK INJ OCCIPITAL
|
Facility
|
OP
|
$717.30
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
412364405
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$1,322.84 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,322.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,322.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,322.84
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$186.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.37
|
|
|
N BLOCK INJ PLANTAR DIGIT
|
Facility
|
OP
|
$1,434.65
|
|
|
Service Code
|
HCPCS 64455
|
| Hospital Charge Code |
412364455
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$45.33 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$991.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,181.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,322.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,322.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$364.67
|
| 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 |
$1,322.84
|
| Rate for Payer: Cigna Commercial |
$730.97
|
| Rate for Payer: Cigna Medicare Advantage |
$364.67
|
| Rate for Payer: Clover Medicare Advantage |
$346.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$375.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$364.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$373.01
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$215.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$364.67
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$835.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$819.40
|
|
|
N BLOCK INJ PLANTAR DIGIT
|
Facility
|
IP
|
$1,434.65
|
|
|
Service Code
|
HCPCS 64455
|
| Hospital Charge Code |
412364455
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$215.20 |
| Max. Negotiated Rate |
$215.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$215.20
|
|
|
N BLOCK INJ,SCIATIC,SNG-RT
|
Facility
|
IP
|
$7,956.80
|
|
|
Service Code
|
HCPCS 64445
|
| Hospital Charge Code |
16000387
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,193.52 |
| Max. Negotiated Rate |
$1,193.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,193.52
|
|
|
N BLOCK INJ,SCIATIC,SNG-RT
|
Facility
|
OP
|
$7,956.80
|
|
|
Service Code
|
HCPCS 64445
|
| Hospital Charge Code |
16000387
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$225.97 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,281.02
|
| Rate for Payer: Aetna Medicare Advantage |
$2,717.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,042.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,042.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$838.61
|
| 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 |
$3,042.06
|
| Rate for Payer: Cigna Commercial |
$1,680.99
|
| Rate for Payer: Cigna Medicare Advantage |
$838.61
|
| Rate for Payer: Clover Medicare Advantage |
$796.68
|
| Rate for Payer: EmblemHealth Commercial |
$2,515.83
|
| Rate for Payer: Humana Medicare Advantage |
$863.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$838.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,068.77
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,193.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.43
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$225.97
|
|
|
N BLOCK OTHER PERIPHERAL
|
Facility
|
OP
|
$3,185.75
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
412364450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$3,042.06 |
| Rate for Payer: Aetna Commercial |
$2,281.02
|
| Rate for Payer: Aetna Medicare Advantage |
$2,717.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,042.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,042.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$838.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,042.06
|
| Rate for Payer: Cigna Commercial |
$1,680.99
|
| Rate for Payer: Cigna Medicare Advantage |
$838.61
|
| Rate for Payer: Clover Medicare Advantage |
$796.68
|
| Rate for Payer: EmblemHealth Commercial |
$2,515.83
|
| Rate for Payer: Humana Medicare Advantage |
$863.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$838.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$828.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$477.86
|
| Rate for Payer: UnitedHealthcare Community & State |
$100.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$90.48
|
|
|
N BLOCK OTHER PERIPHERAL
|
Facility
|
IP
|
$3,185.75
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
412364450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$477.86 |
| Max. Negotiated Rate |
$477.86 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$477.86
|
|