|
CH AMYLASE 2HR URINE
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
397071205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$17.63
|
| Rate for Payer: Aetna Medicare Advantage |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.39
|
| Rate for Payer: Cigna Commercial |
$97.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6.48
|
| Rate for Payer: Clover Medicare Advantage |
$6.16
|
| Rate for Payer: EmblemHealth Commercial |
$19.44
|
| Rate for Payer: Humana Medicare Advantage |
$6.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.17
|
|
|
CH AMYLASE 2HR URINE
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
397071205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.25
|
|
|
CH AMYLASE FLUID
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
397073047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$17.63
|
| Rate for Payer: Aetna Medicare Advantage |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.39
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.48
|
| Rate for Payer: Clover Medicare Advantage |
$6.16
|
| Rate for Payer: EmblemHealth Commercial |
$19.44
|
| Rate for Payer: Humana Medicare Advantage |
$6.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.44
|
|
|
CH AMYLASE FLUID
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
397073047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$13.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.80
|
|
|
CH AMYLASE ISOENZYMES
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
397072028
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$447.50 |
| Rate for Payer: Aetna Commercial |
$167.28
|
| Rate for Payer: Aetna Medicare Advantage |
$199.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$61.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$222.00
|
| Rate for Payer: Cigna Commercial |
$447.50
|
| Rate for Payer: Cigna Medicare Advantage |
$61.50
|
| Rate for Payer: Clover Medicare Advantage |
$58.42
|
| Rate for Payer: EmblemHealth Commercial |
$184.50
|
| Rate for Payer: Humana Medicare Advantage |
$63.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$61.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$268.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$134.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$49.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.72
|
|
|
CH AMYLASE ISOENZYMES
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
397073258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$151.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$151.80
|
|
|
CH AMYLASE ISOENZYMES
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
397073258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$506.00 |
| Rate for Payer: Aetna Commercial |
$167.28
|
| Rate for Payer: Aetna Medicare Advantage |
$199.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$61.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$222.00
|
| Rate for Payer: Cigna Commercial |
$506.00
|
| Rate for Payer: Cigna Medicare Advantage |
$61.50
|
| Rate for Payer: Clover Medicare Advantage |
$58.42
|
| Rate for Payer: EmblemHealth Commercial |
$184.50
|
| Rate for Payer: Humana Medicare Advantage |
$63.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$61.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$303.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$151.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$49.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.82
|
|
|
CH AMYLASE ISOENZYMES
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
HCPCS 82664
|
| Hospital Charge Code |
397072028
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$134.25 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$134.25
|
|
|
CH AMYLASE RANDOM URINE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
397073106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$17.63
|
| Rate for Payer: Aetna Medicare Advantage |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.39
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.48
|
| Rate for Payer: Clover Medicare Advantage |
$6.16
|
| Rate for Payer: EmblemHealth Commercial |
$19.44
|
| Rate for Payer: Humana Medicare Advantage |
$6.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH AMYLASE RANDOM URINE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
397073106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH ANA
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
397041355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH ANA
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
397041355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$32.88
|
| Rate for Payer: Aetna Medicare Advantage |
$39.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.64
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$12.09
|
| Rate for Payer: Clover Medicare Advantage |
$11.49
|
| Rate for Payer: EmblemHealth Commercial |
$36.27
|
| Rate for Payer: Humana Medicare Advantage |
$12.45
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.28
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
CH ANA TITER
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
397041297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH ANA TITER
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
397041297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$30.36
|
| Rate for Payer: Aetna Medicare Advantage |
$36.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.28
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.16
|
| Rate for Payer: Clover Medicare Advantage |
$10.60
|
| Rate for Payer: EmblemHealth Commercial |
$33.48
|
| Rate for Payer: Humana Medicare Advantage |
$11.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.93
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH ANCA SCR W/MPO/PR3, W/RFL
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
397071384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$365.50 |
| Rate for Payer: Aetna Commercial |
$40.94
|
| Rate for Payer: Aetna Medicare Advantage |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.33
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: Cigna Medicare Advantage |
$15.05
|
| Rate for Payer: Clover Medicare Advantage |
$14.30
|
| Rate for Payer: EmblemHealth Commercial |
$45.15
|
| Rate for Payer: Humana Medicare Advantage |
$15.50
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.37
|
|
|
CH ANCA SCR W/MPO/PR3, W/RFL
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
397071384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$109.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.65
|
|
|
CHANDPER V PACING PROBE***
|
Facility
|
OP
|
$181.00
|
|
| Hospital Charge Code |
8003113
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$90.50 |
| Rate for Payer: Aetna Commercial |
$68.78
|
| Rate for Payer: Aetna Medicare Advantage |
$54.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.16
|
| Rate for Payer: Cigna Commercial |
$90.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.30
|
| Rate for Payer: Oxford Commercial |
$36.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.80
|
|
|
CHANDPER V PACING PROBE***
|
Facility
|
IP
|
$181.00
|
|
| Hospital Charge Code |
8003113
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.15
|
|
|
CH ANDROSTANEDIOL GLUCRONIDE
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
HCPCS 82154
|
| Hospital Charge Code |
397073352
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.85
|
|
|
CH ANDROSTANEDIOL GLUCRONIDE
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS 82154
|
| Hospital Charge Code |
397073352
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$78.42
|
| Rate for Payer: Aetna Medicare Advantage |
$93.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$104.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$104.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$28.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$104.07
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: Cigna Medicare Advantage |
$28.83
|
| Rate for Payer: Clover Medicare Advantage |
$27.39
|
| Rate for Payer: EmblemHealth Commercial |
$86.49
|
| Rate for Payer: Humana Medicare Advantage |
$29.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$28.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$28.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.16
|
|
|
CH ANDROSTENEDIONE
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
HCPCS 82157
|
| Hospital Charge Code |
397072029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$155.70 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.70
|
|
|
CH ANDROSTENEDIONE
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
HCPCS 82157
|
| Hospital Charge Code |
397072029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: Aetna Commercial |
$79.64
|
| Rate for Payer: Aetna Medicare Advantage |
$94.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.69
|
| Rate for Payer: Cigna Commercial |
$519.00
|
| Rate for Payer: Cigna Medicare Advantage |
$29.28
|
| Rate for Payer: Clover Medicare Advantage |
$27.82
|
| Rate for Payer: EmblemHealth Commercial |
$87.84
|
| Rate for Payer: Humana Medicare Advantage |
$30.16
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$29.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$311.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.51
|
|
|
CH ANDRROSTANEDIOL GLUCURON
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS 82154
|
| Hospital Charge Code |
397073347
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$78.42
|
| Rate for Payer: Aetna Medicare Advantage |
$93.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$104.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$104.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$28.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$104.07
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: Cigna Medicare Advantage |
$28.83
|
| Rate for Payer: Clover Medicare Advantage |
$27.39
|
| Rate for Payer: EmblemHealth Commercial |
$86.49
|
| Rate for Payer: Humana Medicare Advantage |
$29.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$28.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$28.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.16
|
|
|
CH ANDRROSTANEDIOL GLUCURON
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
HCPCS 82154
|
| Hospital Charge Code |
397073347
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.85
|
|
|
CHANGE OF BLADDER TUBE
|
Facility
|
OP
|
$543.70
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
1001160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.11
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.41
|
|
