|
CH ANTI GLIAIAN AB IGG
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.60
|
|
|
CH ANTI GLIAIAN AB IGG
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$72.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.82
|
|
|
CH ANTI GLOMERULAR BSMT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
397071230
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.60
|
|
|
CH ANTI GLOMERULAR BSMT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
397071230
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare Advantage |
$39.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.50
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.45
|
| Rate for Payer: EmblemHealth Commercial |
$36.15
|
| Rate for Payer: Humana Medicare Advantage |
$12.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.88
|
|
|
CH ANTI MULLERIAN HORMONE
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$52.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.76
|
|
|
CH ANTI MULLERIAN HORMONE
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$214.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.37
|
|
|
CH ANTI MULLERIAN HORMONE
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.60
|
|
|
CH ANTI MULLERIAN HORMONE
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.35
|
|
|
CH ANTI MYELOPEROXIDASE
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
HCPCS 88319
|
| Hospital Charge Code |
397073153
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$141.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.60
|
|
|
CH ANTI MYELOPEROXIDASE
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
HCPCS 88319
|
| Hospital Charge Code |
397073153
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$3,455.10 |
| Rate for Payer: Aetna Commercial |
$2,603.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,101.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,455.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,455.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$957.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,455.10
|
| Rate for Payer: Cigna Commercial |
$1,918.64
|
| Rate for Payer: Cigna Medicare Advantage |
$957.17
|
| Rate for Payer: Clover Medicare Advantage |
$909.31
|
| Rate for Payer: EmblemHealth Commercial |
$2,871.51
|
| Rate for Payer: Humana Medicare Advantage |
$985.89
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$957.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$111.97
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$957.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$957.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.02
|
|
|
CH ANTI NEUTROPHIL CYTO AB
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
397041155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$217.50 |
| 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 |
$217.50
|
| 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 |
$130.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.25
|
| 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 |
$11.53
|
|
|
CH ANTI NEUTROPHIL CYTO AB
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
397041155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.25
|
|
|
CH ANTI PLATELET ANTIBODY
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
397071226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$211.00 |
| Rate for Payer: Aetna Commercial |
$49.97
|
| Rate for Payer: Aetna Medicare Advantage |
$59.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.37
|
| 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 |
$66.31
|
| Rate for Payer: Cigna Commercial |
$211.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.37
|
| Rate for Payer: Clover Medicare Advantage |
$17.45
|
| Rate for Payer: EmblemHealth Commercial |
$55.11
|
| Rate for Payer: Humana Medicare Advantage |
$18.92
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$126.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.18
|
|
|
CH ANTI PLATELET ANTIBODY
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
397071226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.30 |
| Max. Negotiated Rate |
$63.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.30
|
|
|
CH ANTI RH (D)
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
397031154
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.15
|
|
|
CH ANTI RH (D)
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
397031154
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna Medicare Advantage |
$9.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.79
|
| Rate for Payer: Cigna Commercial |
$88.94
|
| Rate for Payer: Cigna Medicare Advantage |
$2.99
|
| Rate for Payer: Clover Medicare Advantage |
$2.84
|
| Rate for Payer: EmblemHealth Commercial |
$8.97
|
| Rate for Payer: Humana Medicare Advantage |
$3.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.68
|
|
|
CH ANTI. S. CEREVISIAE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
397073659
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
|
|
CH ANTI. S. CEREVISIAE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
397073659
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$44.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.22
|
| 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 |
$31.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.22
|
| Rate for Payer: Cigna Commercial |
$105.00
|
| 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 |
$63.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.57
|
|
|
CH ANTI SKIN AB
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
397073104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare Advantage |
$39.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.50
|
| Rate for Payer: Cigna Commercial |
$80.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.45
|
| Rate for Payer: EmblemHealth Commercial |
$36.15
|
| Rate for Payer: Humana Medicare Advantage |
$12.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.27
|
|
|
CH ANTI SKIN AB
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
397073104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.15
|
|
|
CH ANTI STREPTOLYSIN O
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
397041230
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna Medicare Advantage |
$23.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.35
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$7.30
|
| Rate for Payer: Clover Medicare Advantage |
$6.93
|
| Rate for Payer: EmblemHealth Commercial |
$21.90
|
| Rate for Payer: Humana Medicare Advantage |
$7.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.30
|
| 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 |
$5.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH ANTI STREPTOLYSIN O
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
397041230
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH ANTI THROMBIN 3
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
397071224
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.23
|
| Rate for Payer: Aetna Medicare Advantage |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.85
|
| 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 |
$42.77
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.85
|
| Rate for Payer: Clover Medicare Advantage |
$11.26
|
| Rate for Payer: EmblemHealth Commercial |
$35.55
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
|
CH ANTI THROMBIN 3
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
397071224
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
CH ANTITHROMBIN III ACT REFL
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
397071541
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$10.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.65
|
|
