|
SERUM BACTERICIDAL TITER
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 87197
|
| Hospital Charge Code |
38477103
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$40.85
|
| Rate for Payer: Aetna Medicare Advantage |
$48.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.49
|
| Rate for Payer: Cigna Commercial |
$41.00
|
| Rate for Payer: Cigna Medicare Advantage |
$15.02
|
| Rate for Payer: Clover Medicare Advantage |
$14.27
|
| Rate for Payer: EmblemHealth Commercial |
$45.06
|
| Rate for Payer: Humana Medicare Advantage |
$15.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.32
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.33
|
|
|
SERUM LEISHMANIA ANTIBODY
|
Facility
|
IP
|
$157.30
|
|
|
Service Code
|
HCPCS 86717
|
| Hospital Charge Code |
401382724
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$23.59 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.59
|
|
|
SERUM LEISHMANIA ANTIBODY
|
Facility
|
OP
|
$157.30
|
|
|
Service Code
|
HCPCS 86717
|
| Hospital Charge Code |
401382724
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$33.32
|
| Rate for Payer: Aetna Medicare Advantage |
$39.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.44
|
| Rate for Payer: Cigna Commercial |
$78.65
|
| Rate for Payer: Cigna Medicare Advantage |
$12.25
|
| Rate for Payer: Clover Medicare Advantage |
$11.64
|
| Rate for Payer: EmblemHealth Commercial |
$36.75
|
| Rate for Payer: Humana Medicare Advantage |
$12.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.90
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.47
|
|
|
SERUM LIVER ANTIGEN LC-1 CYTOS
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
401386377
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$39.58
|
| Rate for Payer: Aetna Medicare Advantage |
$47.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.78
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.55
|
| Rate for Payer: Clover Medicare Advantage |
$13.82
|
| Rate for Payer: EmblemHealth Commercial |
$43.65
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.20
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.25
|
|
|
SERUM LIVER ANTIGEN LC-1 CYTOS
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
401386377
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
SERUM OXYCODONE QUART
|
Facility
|
IP
|
$121.26
|
|
|
Service Code
|
HCPCS 80365
|
| Hospital Charge Code |
39900532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.19
|
|
|
SERUM OXYCODONE QUART
|
Facility
|
OP
|
$121.26
|
|
|
Service Code
|
HCPCS 80365
|
| Hospital Charge Code |
39900532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$46.08
|
| Rate for Payer: Aetna Medicare Advantage |
$36.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.92
|
| Rate for Payer: Cigna Commercial |
$60.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.53
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.44
|
|
|
SERUM PROTEIN ELECTROPHORESES
|
Facility
|
IP
|
$73.80
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3990131B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.07
|
|
|
SERUM PROTEIN ELECTROPHORESES
|
Facility
|
OP
|
$73.80
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3990131B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$29.21
|
| Rate for Payer: Aetna Medicare Advantage |
$34.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.96
|
| Rate for Payer: Cigna Commercial |
$36.90
|
| Rate for Payer: Cigna Medicare Advantage |
$10.74
|
| Rate for Payer: Clover Medicare Advantage |
$10.20
|
| Rate for Payer: EmblemHealth Commercial |
$32.22
|
| Rate for Payer: Humana Medicare Advantage |
$11.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.19
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.10
|
|
|
SERUM PROTEIN ELECTROPHORESIS
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
39990131B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
SERUM PROTEIN ELECTROPHORESIS
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
39990131B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$29.21
|
| Rate for Payer: Aetna Medicare Advantage |
$34.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.96
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$10.74
|
| Rate for Payer: Clover Medicare Advantage |
$10.20
|
| Rate for Payer: EmblemHealth Commercial |
$32.22
|
| Rate for Payer: Humana Medicare Advantage |
$11.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.74
|
| 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 |
$8.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
SERUM PROTEIN ELECTROPHORESIS
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
39990131A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
SERUM PROTEIN ELECTROPHORESIS
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
39990131A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$9.98
|
| Rate for Payer: Aetna Medicare Advantage |
$11.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.31
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$3.67
|
| Rate for Payer: Clover Medicare Advantage |
$3.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.01
|
| Rate for Payer: Humana Medicare Advantage |
$3.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.67
|
| 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 |
$2.94
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
SERUM VISCOSITY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85810
|
| Hospital Charge Code |
39900427
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$31.74
|
| Rate for Payer: Aetna Medicare Advantage |
$37.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.33
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.67
|
| Rate for Payer: Clover Medicare Advantage |
$11.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.01
|
| Rate for Payer: Humana Medicare Advantage |
$12.02
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.67
|
| 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 |
$9.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
SERUM VISCOSITY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85810
|
| Hospital Charge Code |
39900427
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
SESAMOIDECTOMY FIRST TOE
|
Facility
|
IP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28315
|
| Hospital Charge Code |
16000452
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,999.79 |
| Max. Negotiated Rate |
$2,999.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,999.79
|
|
|
SESAMOIDECTOMY FIRST TOE
|
Facility
|
OP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28315
|
| Hospital Charge Code |
16000452
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$567.96 |
| Max. Negotiated Rate |
$14,100.89 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| 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 |
$14,100.89
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,199.64
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,999.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$631.96
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$567.96
|
|
|
SET CATH CHOLANGIO C1002
|
Facility
|
OP
|
$340.00
|
|
| Hospital Charge Code |
270627916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare Advantage |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.70
|
| Rate for Payer: Cigna Commercial |
$170.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.40
|
| Rate for Payer: Oxford Commercial |
$68.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.66
|
|
|
SET CATH CHOLANGIO C1002
|
Facility
|
IP
|
$340.00
|
|
| Hospital Charge Code |
270627916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.00
|
|
|
SET CATH RADIAL ART FEP 22G
|
Facility
|
IP
|
$46.61
|
|
| Hospital Charge Code |
270606560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.99
|
|
|
SET CATH RADIAL ART FEP 22G
|
Facility
|
OP
|
$46.61
|
|
| Hospital Charge Code |
270606560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$23.30 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Medicare Advantage |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.89
|
| Rate for Payer: Cigna Commercial |
$23.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.12
|
| Rate for Payer: Oxford Commercial |
$9.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.32
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.32
|
|
|
SET CATH STAMEY PERC SUPRA
|
Facility
|
IP
|
$216.00
|
|
| Hospital Charge Code |
270684724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.40
|
|
|
SET CATH STAMEY PERC SUPRA
|
Facility
|
OP
|
$216.00
|
|
| Hospital Charge Code |
270684724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$82.08
|
| Rate for Payer: Aetna Medicare Advantage |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$55.08
|
| Rate for Payer: Cigna Commercial |
$108.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.16
|
| Rate for Payer: Oxford Commercial |
$43.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$43.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.13
|
|
|
SET CHOLANGIO W/BALLOON CATH
|
Facility
|
IP
|
$577.50
|
|
| Hospital Charge Code |
270605529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.62 |
| Max. Negotiated Rate |
$86.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.62
|
|
|
SET CHOLANGIO W/BALLOON CATH
|
Facility
|
OP
|
$577.50
|
|
| Hospital Charge Code |
270605529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$288.75 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Aetna Medicare Advantage |
$173.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$147.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$147.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$147.26
|
| Rate for Payer: Cigna Commercial |
$288.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$150.15
|
| Rate for Payer: Oxford Commercial |
$115.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$115.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.40
|
|
