|
PRODISC C VIVO 15X14MM H6MM
|
Facility
|
OP
|
$29,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$844.90 |
| Max. Negotiated Rate |
$14,875.00 |
| Rate for Payer: Aetna Commercial |
$11,305.00
|
| Rate for Payer: Aetna Medicare Advantage |
$8,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,586.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,586.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,586.25
|
| Rate for Payer: Cigna Commercial |
$14,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,199.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,462.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$940.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$844.90
|
|
|
PRODISC C VIVO 17X14MM H5MM
|
Facility
|
OP
|
$29,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$844.90 |
| Max. Negotiated Rate |
$14,875.00 |
| Rate for Payer: Aetna Commercial |
$11,305.00
|
| Rate for Payer: Aetna Medicare Advantage |
$8,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,586.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,586.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,586.25
|
| Rate for Payer: Cigna Commercial |
$14,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,199.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,462.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$940.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$844.90
|
|
|
PRODISC C VIVO 17X14MM H5MM
|
Facility
|
IP
|
$29,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,462.50 |
| Max. Negotiated Rate |
$7,199.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,199.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,462.50
|
|
|
PRODISC C VIVO 17X14X6MM
|
Facility
|
OP
|
$29,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270705157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$844.90 |
| Max. Negotiated Rate |
$14,875.00 |
| Rate for Payer: Aetna Commercial |
$11,305.00
|
| Rate for Payer: Aetna Medicare Advantage |
$8,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,586.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,586.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,586.25
|
| Rate for Payer: Cigna Commercial |
$14,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,199.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,462.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$940.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$844.90
|
|
|
PRODISC C VIVO 17X14X6MM
|
Facility
|
IP
|
$29,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270705157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,462.50 |
| Max. Negotiated Rate |
$7,199.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,199.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,462.50
|
|
|
PRODISC C VIVO 7X16MM H5MM
|
Facility
|
OP
|
$29,750.00
|
|
| Hospital Charge Code |
270702660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$844.90 |
| Max. Negotiated Rate |
$14,875.00 |
| Rate for Payer: Aetna Commercial |
$11,305.00
|
| Rate for Payer: Aetna Medicare Advantage |
$8,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,586.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,586.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,586.25
|
| Rate for Payer: Cigna Commercial |
$14,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,199.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,462.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$940.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$844.90
|
|
|
PRODISC C VIVO 7X16MM H5MM
|
Facility
|
IP
|
$29,750.00
|
|
| Hospital Charge Code |
270702660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,462.50 |
| Max. Negotiated Rate |
$7,199.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,199.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,462.50
|
|
|
PRODISC-C VIVO LD 17X16X6MM
|
Facility
|
OP
|
$42,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Aetna Commercial |
$16,150.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,837.50
|
| Rate for Payer: Cigna Commercial |
$21,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,285.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,375.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,343.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,207.00
|
|
|
PRODISC-C VIVO LD 17X16X6MM
|
Facility
|
IP
|
$42,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,375.00 |
| Max. Negotiated Rate |
$10,285.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,285.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,375.00
|
|
|
PRODISC C VIVO REPLACE MED 5MM
|
Facility
|
IP
|
$42,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,375.00 |
| Max. Negotiated Rate |
$10,285.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,285.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,375.00
|
|
|
PRODISC C VIVO REPLACE MED 5MM
|
Facility
|
OP
|
$42,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Aetna Commercial |
$16,150.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,837.50
|
| Rate for Payer: Cigna Commercial |
$21,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,285.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,375.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,343.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,207.00
|
|
|
PRODUCTFRESH FROZEN PLASMA
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
3100922
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$70.65 |
| Max. Negotiated Rate |
$70.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.65
|
|
|
PRODUCTFRESH FROZEN PLASMA
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
3100922
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$271.95
|
| Rate for Payer: Aetna Medicare Advantage |
$323.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$362.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$362.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$99.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$362.68
|
| Rate for Payer: Cigna Commercial |
$200.40
|
| Rate for Payer: Cigna Medicare Advantage |
$99.98
|
| Rate for Payer: Clover Medicare Advantage |
$94.98
|
| Rate for Payer: EmblemHealth Commercial |
$299.94
|
| Rate for Payer: Humana Medicare Advantage |
$102.98
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$99.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.46
|
| Rate for Payer: Oxford Commercial |
$1,028.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$99.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.38
|
|
|
PROFEE:INTL HSP HI COMP<70 MN
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 99223
|
| Hospital Charge Code |
83652417
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$71.33 |
| Max. Negotiated Rate |
$351.64 |
| Rate for Payer: Aetna Commercial |
$202.08
|
| Rate for Payer: Aetna Medicare Advantage |
$159.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$71.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.33
|
| Rate for Payer: Cigna Commercial |
$351.64
|
| Rate for Payer: Cigna Medicare Advantage |
$351.64
|
| Rate for Payer: Clover Medicare Advantage |
$172.71
|
| Rate for Payer: EmblemHealth Commercial |
$162.22
|
| Rate for Payer: Fidelis All Plans |
$103.68
|
| Rate for Payer: Healthfirst NY All Plans |
$71.33
|
| Rate for Payer: Humana Medicare Advantage |
$172.30
|
| Rate for Payer: Local 1199 Commercial |
$159.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.00
|
| Rate for Payer: Marpai Administrators LLC Commercial |
$238.01
|
| Rate for Payer: MetroPlus Health All Plans |
$71.33
|
| Rate for Payer: Molina Healthcare All Plans |
$71.33
|
| Rate for Payer: Oscar Health Commercial |
$304.64
|
| Rate for Payer: Tricare Tricare |
$182.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$151.74
|
| Rate for Payer: UnitedHealthcare Community & State |
$151.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$151.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$179.40
|
|
|
PROFEE:INTL HSP LW COMP<30 MN
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
83652413
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$68.04 |
| Max. Negotiated Rate |
$266.53 |
| Rate for Payer: Aetna Commercial |
$72.29
|
| Rate for Payer: Aetna Medicare Advantage |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$266.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$266.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$266.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$266.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$266.53
|
| Rate for Payer: Cigna Commercial |
$186.32
|
| Rate for Payer: Cigna Medicare Advantage |
$186.32
|
| Rate for Payer: Clover Medicare Advantage |
$85.05
|
| Rate for Payer: Fidelis All Plans |
$72.44
|
| Rate for Payer: Humana Medicare Advantage |
$68.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$80.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$80.21
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$80.21
|
|
|
PROFEE:INTL HSP MOD SEV<50 MN
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
83652415
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$295.48 |
| Rate for Payer: Aetna Commercial |
$152.95
|
| Rate for Payer: Aetna Medicare Advantage |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.55
|
| Rate for Payer: Cigna Commercial |
$284.76
|
| Rate for Payer: Cigna Medicare Advantage |
$284.76
|
| Rate for Payer: Clover Medicare Advantage |
$127.80
|
| Rate for Payer: EmblemHealth Commercial |
$105.23
|
| Rate for Payer: Fidelis All Plans |
$82.45
|
| Rate for Payer: Healthfirst NY All Plans |
$48.55
|
| Rate for Payer: Humana Medicare Advantage |
$88.58
|
| Rate for Payer: Local 1199 Commercial |
$107.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.23
|
| Rate for Payer: Marpai Administrators LLC Commercial |
$104.37
|
| Rate for Payer: MetroPlus Health All Plans |
$61.45
|
| Rate for Payer: Molina Healthcare All Plans |
$48.55
|
| Rate for Payer: Oscar Health Commercial |
$295.48
|
| Rate for Payer: Tricare Tricare |
$132.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$130.16
|
| Rate for Payer: UnitedHealthcare Community & State |
$130.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$130.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$128.45
|
|
|
PROFEE:OBV INP HSP HI SEVERIT
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 99236
|
| Hospital Charge Code |
83652429
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$102.94 |
| Max. Negotiated Rate |
$213.04 |
| Rate for Payer: Aetna Commercial |
$102.94
|
| Rate for Payer: Aetna Medicare Advantage |
$213.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$108.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$108.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.33
|
| Rate for Payer: Clover Medicare Advantage |
$213.04
|
| Rate for Payer: Fidelis All Plans |
$148.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$213.04
|
| Rate for Payer: UnitedHealthcare Community & State |
$213.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$213.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$213.04
|
|
|
PROFEE:OBV INP HSP MOD SEVERI
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 99235
|
| Hospital Charge Code |
83652427
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$96.27 |
| Max. Negotiated Rate |
$363.03 |
| Rate for Payer: Aetna Medicare Advantage |
$363.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$96.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$96.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$96.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$96.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$96.27
|
| Rate for Payer: Cigna Commercial |
$363.03
|
| Rate for Payer: Cigna Medicare Advantage |
$363.03
|
| Rate for Payer: Clover Medicare Advantage |
$151.84
|
| Rate for Payer: Marpai Administrators LLC Commercial |
$146.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$163.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$163.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$163.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$163.87
|
|
|
PROFEE:SBSQ HSP HI COMP<35 MNT
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 99233
|
| Hospital Charge Code |
83652423
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$321.55 |
| Rate for Payer: Aetna Commercial |
$123.22
|
| Rate for Payer: Aetna Medicare Advantage |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$321.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$321.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$321.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$321.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$321.55
|
| Rate for Payer: Cigna Commercial |
$206.40
|
| Rate for Payer: Cigna Medicare Advantage |
$206.40
|
| Rate for Payer: Clover Medicare Advantage |
$117.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$113.35
|
| Rate for Payer: EmblemHealth Commercial |
$28.71
|
| Rate for Payer: Fidelis All Plans |
$73.84
|
| Rate for Payer: Healthfirst NY All Plans |
$37.65
|
| Rate for Payer: Humana Medicare Advantage |
$90.36
|
| Rate for Payer: Local 1199 Commercial |
$83.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.28
|
| Rate for Payer: Marpai Administrators LLC Commercial |
$83.83
|
| Rate for Payer: MetroPlus Health All Plans |
$37.65
|
| Rate for Payer: Molina Healthcare All Plans |
$37.65
|
| Rate for Payer: Oscar Health Commercial |
$224.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$116.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$116.17
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$116.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$122.26
|
|
|
PROFEE:SBSQ HSP LW COMP<15MN
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 99231
|
| Hospital Charge Code |
83652419
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$121.35 |
| Rate for Payer: Aetna Commercial |
$63.83
|
| Rate for Payer: Aetna Medicare Advantage |
$52.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$121.35
|
| Rate for Payer: Cigna Commercial |
$52.81
|
| Rate for Payer: Cigna Medicare Advantage |
$52.81
|
| Rate for Payer: Clover Medicare Advantage |
$51.97
|
| Rate for Payer: EmblemHealth Commercial |
$50.46
|
| Rate for Payer: Fidelis All Plans |
$33.94
|
| Rate for Payer: Humana Medicare Advantage |
$69.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.87
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$42.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.46
|
|
|
PROFEE:SBSQ HSP MOD COMP<25MN
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 99232
|
| Hospital Charge Code |
83652421
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$223.96 |
| Rate for Payer: Aetna Commercial |
$95.96
|
| Rate for Payer: Aetna Medicare Advantage |
$57.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$223.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$223.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.96
|
| Rate for Payer: Cigna Commercial |
$140.73
|
| Rate for Payer: Cigna Medicare Advantage |
$140.73
|
| Rate for Payer: Clover Medicare Advantage |
$78.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$76.25
|
| Rate for Payer: EmblemHealth Commercial |
$44.23
|
| Rate for Payer: Fidelis All Plans |
$51.04
|
| Rate for Payer: Healthfirst NY All Plans |
$26.27
|
| Rate for Payer: Humana Medicare Advantage |
$77.28
|
| Rate for Payer: Local 1199 Commercial |
$57.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$89.54
|
| Rate for Payer: Marpai Administrators LLC Commercial |
$69.27
|
| Rate for Payer: MetroPlus Health All Plans |
$28.08
|
| Rate for Payer: Molina Healthcare All Plans |
$26.27
|
| Rate for Payer: Oscar Health Commercial |
$156.14
|
| Rate for Payer: Tricare Tricare |
$83.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$51.39
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$51.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$80.18
|
|
|
PROGESTERONE
|
Facility
|
IP
|
$866.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
38472563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$129.90 |
| Max. Negotiated Rate |
$129.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.90
|
|
|
PROGESTERONE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
39900447
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$56.74
|
| Rate for Payer: Aetna Medicare Advantage |
$67.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.67
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.86
|
| Rate for Payer: Clover Medicare Advantage |
$19.82
|
| Rate for Payer: EmblemHealth Commercial |
$62.58
|
| Rate for Payer: Humana Medicare Advantage |
$21.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.86
|
| 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 |
$16.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
PROGESTERONE
|
Facility
|
OP
|
$866.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
38472563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$433.00 |
| Rate for Payer: Aetna Commercial |
$56.74
|
| Rate for Payer: Aetna Medicare Advantage |
$67.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.67
|
| Rate for Payer: Cigna Commercial |
$433.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.86
|
| Rate for Payer: Clover Medicare Advantage |
$19.82
|
| Rate for Payer: EmblemHealth Commercial |
$62.58
|
| Rate for Payer: Humana Medicare Advantage |
$21.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.16
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.59
|
|
|
PROGESTERONE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
39900447
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
