|
BILIARY WALL STENT
|
Facility
|
IP
|
$4,264.00
|
|
| Hospital Charge Code |
270335524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.60 |
| Max. Negotiated Rate |
$1,031.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$852.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,031.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$639.60
|
|
|
BILIRUBIN, DIRECT
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
3000445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
BILIRUBIN, DIRECT
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
3000445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.21
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| 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 |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
BILIRUBIN, DIRECT
|
Facility
|
OP
|
$400.40
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
38472143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.21
|
| Rate for Payer: Cigna Commercial |
$200.20
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.37
|
|
|
BILIRUBIN, DIRECT
|
Facility
|
IP
|
$400.40
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
38472143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$60.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.06
|
|
|
BILIRUBIN,FECES,QUAL
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 82252
|
| Hospital Charge Code |
38477035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.80
|
|
|
BILIRUBIN,FECES,QUAL
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 82252
|
| Hospital Charge Code |
38477035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$12.40
|
| Rate for Payer: Aetna Medicare Advantage |
$14.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.54
|
| Rate for Payer: Cigna Commercial |
$16.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.56
|
| Rate for Payer: Clover Medicare Advantage |
$4.33
|
| Rate for Payer: EmblemHealth Commercial |
$13.68
|
| Rate for Payer: Humana Medicare Advantage |
$4.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.32
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.91
|
|
|
BILIRUBIN, NEONATAL DIR & IND
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
3008422
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.21
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| 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 |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
BILIRUBIN, NEONATAL DIR & IND
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
3008422
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
BILIRUBIN SCAN, AMNIOTIC FLUID
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 82143
|
| Hospital Charge Code |
38473119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
|
|
BILIRUBIN SCAN, AMNIOTIC FLUID
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 82143
|
| Hospital Charge Code |
38473119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$25.43
|
| Rate for Payer: Aetna Medicare Advantage |
$30.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.92
|
| Rate for Payer: Cigna Commercial |
$90.00
|
| Rate for Payer: Cigna Medicare Advantage |
$9.35
|
| Rate for Payer: Clover Medicare Advantage |
$8.88
|
| Rate for Payer: EmblemHealth Commercial |
$28.05
|
| Rate for Payer: Humana Medicare Advantage |
$9.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.80
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.11
|
|
|
BILIRUBIN, TOTAL
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3000437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| 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 |
$18.21
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| 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 |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
BILIRUBIN, TOTAL
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3000437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
BILIRUBIN TOTAL BODY FLUID
|
Facility
|
IP
|
$123.20
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
401182247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$18.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.48
|
|
|
BILIRUBIN TOTAL BODY FLUID
|
Facility
|
OP
|
$123.20
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
401182247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| 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 |
$18.21
|
| Rate for Payer: Cigna Commercial |
$61.60
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.03
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.50
|
|
|
BILIRUBIN,TOTAL,VAN DEN BERGH
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
38472140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| 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 |
$18.21
|
| Rate for Payer: Cigna Commercial |
$122.50
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.70
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.96
|
|
|
BILIRUBIN,TOTAL,VAN DEN BERGH
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
38472140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
BILIRUBIN T TRANS IMMEDIATE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3000438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| 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 |
$18.21
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| 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 |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
BILIRUBIN T TRANS IMMEDIATE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3000438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BILI TRANS POST
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
300439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| 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 |
$18.21
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| 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 |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
BILI TRANS POST
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
300439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BILL AG SCREEN BLD UNIIT, IGG
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
3100211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
BILL AG SCREEN BLD UNIIT, IGG
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
3100211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$853.60 |
| Rate for Payer: Aetna Commercial |
$10.42
|
| Rate for Payer: Aetna Medicare Advantage |
$12.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.89
|
| Rate for Payer: Cigna Commercial |
$853.60
|
| Rate for Payer: Cigna Medicare Advantage |
$3.83
|
| Rate for Payer: Clover Medicare Advantage |
$3.64
|
| Rate for Payer: EmblemHealth Commercial |
$11.49
|
| Rate for Payer: Humana Medicare Advantage |
$3.94
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.83
|
| 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 |
$3.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
BILL BLOOD ADMINISTRATION
|
Facility
|
OP
|
$1,403.75
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3100054
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$39.87 |
| Max. Negotiated Rate |
$1,901.28 |
| Rate for Payer: Aetna Commercial |
$1,425.63
|
| Rate for Payer: Aetna Medicare Advantage |
$1,698.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,901.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,901.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$524.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,901.28
|
| Rate for Payer: Cigna Commercial |
$1,050.61
|
| Rate for Payer: Cigna Medicare Advantage |
$524.13
|
| Rate for Payer: Clover Medicare Advantage |
$497.92
|
| Rate for Payer: EmblemHealth Commercial |
$1,572.39
|
| Rate for Payer: Humana Medicare Advantage |
$539.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$524.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.98
|
| Rate for Payer: Oxford Commercial |
$1,028.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$44.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$524.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$524.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.87
|
|
|
BILL BLOOD ADMINISTRATION
|
Facility
|
IP
|
$1,403.75
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3100054
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$210.56 |
| Max. Negotiated Rate |
$210.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.56
|
|
