|
RW PARING BENIGN 2-4 LESION
|
Facility
|
OP
|
$1,208.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
87502135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.31 |
| Max. Negotiated Rate |
$1,751.90 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,751.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$134.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,751.90
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$314.08
|
| Rate for Payer: Oxford Commercial |
$241.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$181.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$241.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.17
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.31
|
|
|
RW PARING BENIGN 2-4 LESION
|
Facility
|
IP
|
$1,208.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
87502135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.20 |
| Max. Negotiated Rate |
$181.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$181.20
|
|
|
RW PARING BENIGN 2 TO 4 LESION
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
83652023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$864.65 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$864.65
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.00
|
| Rate for Payer: Oxford Commercial |
$130.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.54
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.46
|
|
|
RW PARING BENIGN 2 TO 4 LESION
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
83652023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.50
|
|
|
RW PARING BENIGN >4 LESIONS
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
84206030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.00
|
|
|
RW PARING BENIGN >4 LESIONS
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
84206030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.76 |
| Max. Negotiated Rate |
$864.65 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$43.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$864.65
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$280.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$280.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$44.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.76
|
|
|
RW PARING BENIGN LESION,SINGLE
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
84206025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.80
|
|
|
RW PARING BENIGN LESION,SINGLE
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
84206025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$864.65 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$864.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$864.65
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.12
|
| Rate for Payer: Oxford Commercial |
$102.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$102.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.54
|
|
|
RW PEAKFLOW
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
87502285
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$415.81
|
| Rate for Payer: Aetna Medicare Advantage |
$495.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$554.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$554.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$152.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$554.54
|
| Rate for Payer: Cigna Commercial |
$306.43
|
| Rate for Payer: Cigna Medicare Advantage |
$152.87
|
| Rate for Payer: Clover Medicare Advantage |
$145.23
|
| Rate for Payer: EmblemHealth Commercial |
$458.61
|
| Rate for Payer: Humana Medicare Advantage |
$157.46
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$152.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.66
|
| Rate for Payer: Oxford Commercial |
$2,184.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$152.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.84
|
|
|
RW PEAKFLOW
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
87502285
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.15
|
|
|
RW PEAKFLOW
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
84206290
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$415.81
|
| Rate for Payer: Aetna Medicare Advantage |
$495.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$554.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$554.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$152.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$554.54
|
| Rate for Payer: Cigna Commercial |
$306.43
|
| Rate for Payer: Cigna Medicare Advantage |
$152.87
|
| Rate for Payer: Clover Medicare Advantage |
$145.23
|
| Rate for Payer: EmblemHealth Commercial |
$458.61
|
| Rate for Payer: Humana Medicare Advantage |
$157.46
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$152.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.66
|
| Rate for Payer: Oxford Commercial |
$2,184.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$152.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.84
|
|
|
RW PEAKFLOW
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
84206290
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.15
|
|
|
RW PEDIAREX VACCINE VIAL
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
84206380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$110.64 |
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Aetna Medicare Advantage |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.31
|
| Rate for Payer: Cigna Commercial |
$81.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.60
|
|
|
RW PEDIAREX VACCINE VIAL
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
84206380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$39.20 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.30
|
|
|
RW PHARMACOLOGIC MANAGEMENT
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
HCPCS 90862
|
| Hospital Charge Code |
83652361
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$66.90 |
| Max. Negotiated Rate |
$66.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.90
|
|
|
RW PHARMACOLOGIC MANAGEMENT
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
HCPCS 90862
|
| Hospital Charge Code |
83652361
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: Aetna Commercial |
$169.48
|
| Rate for Payer: Aetna Medicare Advantage |
$133.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$113.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$113.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$113.73
|
| Rate for Payer: Cigna Commercial |
$223.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$115.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.67
|
|
|
RW PNEUMONOCCOCAL VAC
|
Facility
|
OP
|
$1,400.88
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
87502925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$700.44 |
| Rate for Payer: Aetna Commercial |
$532.33
|
| Rate for Payer: Aetna Medicare Advantage |
$420.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$357.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$357.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$357.22
|
| Rate for Payer: Cigna Commercial |
$700.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$339.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.13
|
| Rate for Payer: UnitedHealthcare Community & State |
$44.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.78
|
|
|
RW PNEUMONOCCOCAL VAC
|
Facility
|
IP
|
$1,400.88
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
87502925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.13 |
| Max. Negotiated Rate |
$339.01 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$339.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.13
|
|
|
RW PNEUMOVAX VIAL 0.5ML
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
84206210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
RW PNEUMOVAX VIAL 0.5ML
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
84206210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$51.70 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.14
|
|
|
RW POL VACCINE IPV VIAL
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
84206365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$35.39 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Medicare Advantage |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.85
|
| Rate for Payer: Cigna Commercial |
$35.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.99
|
|
|
RW POL VACCINE IPV VIAL
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
84206365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$16.94 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.50
|
|
|
RW PPD
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
87502305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
RW PPD
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
87502305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$93.46
|
| Rate for Payer: Aetna Medicare Advantage |
$111.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$34.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.64
|
| Rate for Payer: Cigna Commercial |
$68.87
|
| Rate for Payer: Cigna Medicare Advantage |
$34.36
|
| Rate for Payer: Clover Medicare Advantage |
$32.64
|
| Rate for Payer: EmblemHealth Commercial |
$103.08
|
| Rate for Payer: Humana Medicare Advantage |
$35.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$34.36
|
| 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 |
$8.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$34.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
RW PPD
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
84206160
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$93.46
|
| Rate for Payer: Aetna Medicare Advantage |
$111.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$34.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.64
|
| Rate for Payer: Cigna Commercial |
$68.87
|
| Rate for Payer: Cigna Medicare Advantage |
$34.36
|
| Rate for Payer: Clover Medicare Advantage |
$32.64
|
| Rate for Payer: EmblemHealth Commercial |
$103.08
|
| Rate for Payer: Humana Medicare Advantage |
$35.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$34.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.58
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$34.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.94
|
|
