|
PANCURONIUM BROMIDE/1MG/1
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
NDC 409464601
|
| Hospital Charge Code |
60633607
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.41
|
|
|
PANEL 1
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
39708028A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 1
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
39708028A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare Advantage |
$82.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.32
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$25.45
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.45
|
| 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 |
$20.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
PANEL 2
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
39708028B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare Advantage |
$82.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.32
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$25.45
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.45
|
| 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 |
$20.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
PANEL 2
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
39708028B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 3
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
366886146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
PANEL 3
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
366886146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare Advantage |
$82.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.32
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$25.45
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.45
|
| 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 |
$20.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
PANEL 3
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
39708028C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare Advantage |
$82.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.32
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$25.45
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.45
|
| 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 |
$20.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
PANEL 3
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
39708028C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 4
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
39708028D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 4
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
39708028D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare Advantage |
$82.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.32
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$25.45
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.45
|
| 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 |
$20.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
PANEL 5
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
39708028E
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare Advantage |
$82.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.32
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$25.45
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.45
|
| 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 |
$20.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
PANEL 5
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
39708028E
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 6
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
39708028F
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare Advantage |
$82.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.32
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$25.45
|
| Rate for Payer: Clover Medicare Advantage |
$24.18
|
| Rate for Payer: EmblemHealth Commercial |
$76.35
|
| Rate for Payer: Humana Medicare Advantage |
$26.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.45
|
| 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 |
$20.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
PANEL 6
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
39708028F
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 7
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
39708028G
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$43.71
|
| Rate for Payer: Aetna Medicare Advantage |
$52.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.29
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$16.07
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.07
|
| 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 |
$12.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
PANEL 7
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
39708028G
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 8
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
39708028H
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 8
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
39708028H
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$43.71
|
| Rate for Payer: Aetna Medicare Advantage |
$52.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.29
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$16.07
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.07
|
| 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 |
$12.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
PANEL 9
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
39708028I
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PANEL 9
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
39708028I
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$43.71
|
| Rate for Payer: Aetna Medicare Advantage |
$52.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.29
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$16.07
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.07
|
| 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 |
$12.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
PANEL 9
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
366886148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$43.71
|
| Rate for Payer: Aetna Medicare Advantage |
$52.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.29
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.07
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.07
|
| 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 |
$12.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
PANEL 9
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
366886148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
Panel, Gastrointestinal
|
Facility
|
IP
|
$545.40
|
|
|
Service Code
|
HCPCS 38470
|
| Hospital Charge Code |
3000077
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$81.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.81
|
|
|
Panel, Gastrointestinal
|
Facility
|
OP
|
$545.40
|
|
|
Service Code
|
HCPCS 38470
|
| Hospital Charge Code |
3000077
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Aetna Commercial |
$207.25
|
| Rate for Payer: Aetna Medicare Advantage |
$163.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$139.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$139.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$139.08
|
| Rate for Payer: Cigna Commercial |
$272.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$141.80
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.49
|
|
