|
CMV CONVENT., RAPID CULT 11
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
3990162B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CMV CONVENT., RAPID CULT 11
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
3990162B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$53.20
|
| Rate for Payer: Aetna Medicare Advantage |
$63.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.95
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$19.56
|
| Rate for Payer: Clover Medicare Advantage |
$18.58
|
| Rate for Payer: EmblemHealth Commercial |
$58.68
|
| Rate for Payer: Humana Medicare Advantage |
$20.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.56
|
| 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 |
$15.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CMV DNA,PCR
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
38475108
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$88.50
|
|
|
CMV DNA,PCR
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
38475108
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$130.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.29
|
| Rate for Payer: Cigna Commercial |
$295.00
|
| Rate for Payer: Cigna Medicare Advantage |
$35.09
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$88.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.76
|
|
|
CMV DNA Q1 REAL TIME PCR
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
39900293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CMV DNA Q1 REAL TIME PCR
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
39900293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$130.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.29
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$35.09
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.09
|
| 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 |
$28.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CMV DNA,QN,REAL-TIME PCR
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
39900295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CMV DNA,QN,REAL-TIME PCR
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
39900295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$116.52
|
| Rate for Payer: Aetna Medicare Advantage |
$138.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$155.40
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$42.84
|
| Rate for Payer: Clover Medicare Advantage |
$40.70
|
| Rate for Payer: EmblemHealth Commercial |
$128.52
|
| Rate for Payer: Humana Medicare Advantage |
$44.13
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$42.84
|
| 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 |
$34.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$42.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CMV DNA ULTRAQUANT
|
Facility
|
OP
|
$294.40
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
39900294
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$116.52
|
| Rate for Payer: Aetna Medicare Advantage |
$138.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$155.40
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Cigna Medicare Advantage |
$42.84
|
| Rate for Payer: Clover Medicare Advantage |
$40.70
|
| Rate for Payer: EmblemHealth Commercial |
$128.52
|
| Rate for Payer: Humana Medicare Advantage |
$44.13
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$42.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.54
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$42.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.36
|
|
|
CMV DNA ULTRAQUANT
|
Facility
|
IP
|
$294.40
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
39900294
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.16
|
|
|
CMV IGG/IGM I
|
Facility
|
OP
|
$98.95
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
39990091A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare Advantage |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.20
|
| Rate for Payer: Cigna Commercial |
$49.48
|
| Rate for Payer: Cigna Medicare Advantage |
$14.39
|
| Rate for Payer: Clover Medicare Advantage |
$13.67
|
| Rate for Payer: EmblemHealth Commercial |
$43.17
|
| Rate for Payer: Humana Medicare Advantage |
$14.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.73
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.81
|
|
|
CMV IGG/IGM I
|
Facility
|
IP
|
$98.95
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
39990091A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$14.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.84
|
|
|
CMV IGG/IGM II
|
Facility
|
IP
|
$115.75
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
39990091B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.36
|
|
|
CMV IGG/IGM II
|
Facility
|
OP
|
$115.75
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
39990091B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.12
|
| Rate for Payer: Cigna Commercial |
$57.88
|
| Rate for Payer: Cigna Medicare Advantage |
$16.85
|
| Rate for Payer: Clover Medicare Advantage |
$16.01
|
| Rate for Payer: EmblemHealth Commercial |
$50.55
|
| Rate for Payer: Humana Medicare Advantage |
$17.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.09
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.29
|
|
|
CMV NEGATIVE COMPONENT
|
Facility
|
IP
|
$658.00
|
|
| Hospital Charge Code |
38471084
|
|
Hospital Revenue Code
|
382
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$98.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$98.70
|
|
|
CMV NEGATIVE COMPONENT
|
Facility
|
OP
|
$658.00
|
|
| Hospital Charge Code |
38471084
|
|
Hospital Revenue Code
|
382
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$250.04
|
| Rate for Payer: Aetna Medicare Advantage |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$167.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$167.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$167.79
|
| Rate for Payer: Cigna Commercial |
$329.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$171.08
|
| Rate for Payer: Oxford Commercial |
$1,028.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$98.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.69
|
|
|
CNTRL NASL HEMORRH ANT SIMPLE
|
Facility
|
OP
|
$1,049.06
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
1600000348
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$29.79 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| 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 |
$573.36
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.76
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.79
|
|
|
CNTRL NASL HEMORRH ANT SIMPLE
|
Facility
|
IP
|
$1,049.06
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
1600000348
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.36 |
| Max. Negotiated Rate |
$157.36 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.36
|
|
|
CNTRL OROPHAR HEMORRH,REQ SURG
|
Facility
|
OP
|
$40,491.68
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
1600000501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,149.96 |
| Max. Negotiated Rate |
$14,288.18 |
| Rate for Payer: Aetna Commercial |
$10,713.67
|
| Rate for Payer: Aetna Medicare Advantage |
$12,761.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,288.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,288.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,938.85
|
| 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 |
$14,288.18
|
| Rate for Payer: Cigna Commercial |
$7,895.42
|
| Rate for Payer: Cigna Medicare Advantage |
$3,938.85
|
| Rate for Payer: Clover Medicare Advantage |
$3,741.91
|
| Rate for Payer: EmblemHealth Commercial |
$11,816.55
|
| Rate for Payer: Humana Medicare Advantage |
$4,057.02
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,938.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,527.84
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,073.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,279.54
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,938.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,938.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,149.96
|
|
|
CNTRL OROPHAR HEMORRH,REQ SURG
|
Facility
|
IP
|
$40,491.68
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
1600000501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,073.75 |
| Max. Negotiated Rate |
$6,073.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,073.75
|
|
|
CNTRL ORPHARYNG HEMORRAH,COMPL
|
Facility
|
OP
|
$9,263.26
|
|
|
Service Code
|
HCPCS 42961
|
| Hospital Charge Code |
16000584
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$263.08 |
| Max. Negotiated Rate |
$8,192.00 |
| Rate for Payer: Aetna Commercial |
$3,520.04
|
| Rate for Payer: Aetna Medicare Advantage |
$2,778.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,362.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,362.13
|
| 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 |
$2,362.13
|
| Rate for Payer: Cigna Commercial |
$4,631.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,408.45
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,389.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$292.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$263.08
|
|
|
CNTRL ORPHARYNG HEMORRAH,COMPL
|
Facility
|
IP
|
$9,263.26
|
|
|
Service Code
|
HCPCS 42961
|
| Hospital Charge Code |
16000584
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.49 |
| Max. Negotiated Rate |
$1,389.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,389.49
|
|
|
CNTRL VENOUS CATHTER STRPNG
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
2600057
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
CNTRL VENOUS CATHTER STRPNG
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
2600057
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.65 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,938.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
CNTRL VENOUS CATHTER STRPNG
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
321075901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
