|
CH BILIRUBIN,NEONATAL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
397071260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.12
|
| 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 |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.12
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| 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 |
$12.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| 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 |
$1.06
|
|
|
CH BILIRUBIN,NEONATAL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
397071260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CH BILIRUBIN TOTAL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
397071140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CH BILIRUBIN TOTAL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
397071140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.12
|
| 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 |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.12
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| 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 |
$12.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| 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 |
$1.06
|
|
|
CH BIRCH (T3) IGE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397071433
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
|
|
CH BIRCH (T3) IGE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397071433
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.84
|
| Rate for Payer: Cigna Commercial |
$55.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.22
|
| Rate for Payer: Clover Medicare Advantage |
$4.96
|
| Rate for Payer: EmblemHealth Commercial |
$15.66
|
| Rate for Payer: Humana Medicare Advantage |
$5.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.92
|
|
|
CH BK VIRUS DNA,QN,RTPCR URN
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
397071370
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$63.30 |
| Max. Negotiated Rate |
$63.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.30
|
|
|
CH BK VIRUS DNA,QN,RTPCR URN
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
397071370
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$211.00 |
| 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 |
$154.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.64
|
| 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 |
$46.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.64
|
| Rate for Payer: Cigna Commercial |
$211.00
|
| 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 |
$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 |
$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 |
$11.18
|
|
|
CH BLADDER TUMOR ANTIGEN
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
397073201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare Advantage |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.12
|
| Rate for Payer: Cigna Commercial |
$79.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.81
|
| Rate for Payer: Clover Medicare Advantage |
$19.77
|
| Rate for Payer: EmblemHealth Commercial |
$62.43
|
| Rate for Payer: Humana Medicare Advantage |
$21.43
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.19
|
|
|
CH BLADDER TUMOR ANTIGEN
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
397073201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$23.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.70
|
|
|
CH BLEEDING TIME
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 85002
|
| Hospital Charge Code |
397021040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$13.11
|
| Rate for Payer: Aetna Medicare Advantage |
$15.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.40
|
| Rate for Payer: Cigna Commercial |
$57.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.82
|
| Rate for Payer: Clover Medicare Advantage |
$4.58
|
| Rate for Payer: EmblemHealth Commercial |
$14.46
|
| Rate for Payer: Humana Medicare Advantage |
$4.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.02
|
|
|
CH BLEEDING TIME
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 85002
|
| Hospital Charge Code |
397021040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.10
|
|
|
CH BLOOD LEUKO DEGLYC WASHED
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
HCPCS P9054
|
| Hospital Charge Code |
397031169
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$265.65 |
| Max. Negotiated Rate |
$265.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$265.65
|
|
|
CH BLOOD LEUKO DEGLYC WASHED
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
HCPCS P9054
|
| Hospital Charge Code |
397031169
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$838.77
|
| Rate for Payer: Aetna Medicare Advantage |
$999.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,113.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,113.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$308.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,113.12
|
| Rate for Payer: Cigna Commercial |
$618.15
|
| Rate for Payer: Cigna Medicare Advantage |
$308.37
|
| Rate for Payer: Clover Medicare Advantage |
$292.95
|
| Rate for Payer: EmblemHealth Commercial |
$925.11
|
| Rate for Payer: Humana Medicare Advantage |
$317.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$308.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$531.30
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$265.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$308.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$308.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.93
|
|
|
CH BLOODLINE AUTO
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
397031030
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
|
|
CH BLOODLINE AUTO
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
397031030
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$492.92
|
| Rate for Payer: Aetna Medicare Advantage |
$587.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$654.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$654.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$181.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$654.15
|
| Rate for Payer: Cigna Commercial |
$363.24
|
| Rate for Payer: Cigna Medicare Advantage |
$181.22
|
| Rate for Payer: Clover Medicare Advantage |
$172.16
|
| Rate for Payer: EmblemHealth Commercial |
$543.66
|
| Rate for Payer: Humana Medicare Advantage |
$186.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$181.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.50
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$181.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.42
|
|
|
CH BLOODLINE DIRECTED
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
397031031
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
|
|
CH BLOODLINE DIRECTED
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
397031031
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.50
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$181.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.42
|
| Rate for Payer: Aetna Commercial |
$492.92
|
| Rate for Payer: Aetna Medicare Advantage |
$587.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$654.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$654.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$181.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$654.15
|
| Rate for Payer: Cigna Commercial |
$363.24
|
| Rate for Payer: Cigna Medicare Advantage |
$181.22
|
| Rate for Payer: Clover Medicare Advantage |
$172.16
|
| Rate for Payer: EmblemHealth Commercial |
$543.66
|
| Rate for Payer: Humana Medicare Advantage |
$186.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$181.22
|
|
|
CH BLOOD PROD IRRADIATED
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS P9056
|
| Hospital Charge Code |
397031043
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$116.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.70
|
|
|
CH BLOOD PROD IRRADIATED
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
HCPCS P9056
|
| Hospital Charge Code |
397031043
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$267.43
|
| Rate for Payer: Aetna Medicare Advantage |
$318.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$354.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$354.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$98.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$354.91
|
| Rate for Payer: Cigna Commercial |
$197.08
|
| Rate for Payer: Cigna Medicare Advantage |
$98.32
|
| Rate for Payer: Clover Medicare Advantage |
$93.40
|
| Rate for Payer: EmblemHealth Commercial |
$294.96
|
| Rate for Payer: Humana Medicare Advantage |
$101.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$98.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$233.40
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$98.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.62
|
|
|
CH BLOOD SPLIT UNIT
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
397031160
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$103.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.95
|
|
|
CH BLOOD SPLIT UNIT
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
397031160
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$492.92
|
| Rate for Payer: Aetna Medicare Advantage |
$587.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$654.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$654.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$181.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$654.15
|
| Rate for Payer: Cigna Commercial |
$363.24
|
| Rate for Payer: Cigna Medicare Advantage |
$181.22
|
| Rate for Payer: Clover Medicare Advantage |
$172.16
|
| Rate for Payer: EmblemHealth Commercial |
$543.66
|
| Rate for Payer: Humana Medicare Advantage |
$186.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$181.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.90
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$181.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.36
|
|
|
CH BLOOD TRANSFUSION
|
Facility
|
IP
|
$1,403.75
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
397031003
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$210.56 |
| Max. Negotiated Rate |
$210.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.56
|
|
|
CH BLOOD TRANSFUSION
|
Facility
|
OP
|
$1,403.75
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
397031003
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$33.83 |
| Max. Negotiated Rate |
$1,891.95 |
| 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 |
$1,891.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,891.95
|
| 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 |
$1,891.95
|
| 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 |
$421.12
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$524.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$524.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.20
|
|
|
CH BLOOD WHOLE LEUK IRRAD
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS P9056
|
| Hospital Charge Code |
397031171
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$267.43
|
| Rate for Payer: Aetna Medicare Advantage |
$318.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$354.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$354.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$98.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$354.91
|
| Rate for Payer: Cigna Commercial |
$197.08
|
| Rate for Payer: Cigna Medicare Advantage |
$98.32
|
| Rate for Payer: Clover Medicare Advantage |
$93.40
|
| Rate for Payer: EmblemHealth Commercial |
$294.96
|
| Rate for Payer: Humana Medicare Advantage |
$101.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$98.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$244.50
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$122.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$98.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.60
|
|
