|
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
|
|
|
CH B PERTUSSIS CULTURE NASAL
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
397071518
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.40
|
|
|
CH B PERTUSSIS CULTURE NASAL
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
397071518
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$18.03
|
| Rate for Payer: Aetna Medicare Advantage |
$21.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.93
|
| Rate for Payer: Cigna Commercial |
$38.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.63
|
| Rate for Payer: Clover Medicare Advantage |
$6.30
|
| Rate for Payer: EmblemHealth Commercial |
$19.89
|
| Rate for Payer: Humana Medicare Advantage |
$6.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.01
|
|
|
CH C1 INHIBITOR FUNCTIONAL
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
397073672
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$217.50 |
| Rate for Payer: Aetna Commercial |
$32.64
|
| Rate for Payer: Aetna Medicare Advantage |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.00
|
| 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 |
$43.32
|
| Rate for Payer: Cigna Commercial |
$217.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.00
|
| Rate for Payer: Clover Medicare Advantage |
$11.40
|
| Rate for Payer: EmblemHealth Commercial |
$36.00
|
| Rate for Payer: Humana Medicare Advantage |
$12.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.00
|
| 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 |
$9.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.53
|
|
|
CH C1 INHIBITOR FUNCTIONAL
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
397073672
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.25
|
|
|
CH C3 FLUID
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397073337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.64
|
| Rate for Payer: Aetna Medicare Advantage |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.00
|
| 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 |
$43.32
|
| Rate for Payer: Cigna Commercial |
$119.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.00
|
| Rate for Payer: Clover Medicare Advantage |
$11.40
|
| Rate for Payer: EmblemHealth Commercial |
$36.00
|
| Rate for Payer: Humana Medicare Advantage |
$12.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.33
|
|
|
CH C3 FLUID
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397073337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$35.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.85
|
|
|
CH C4 FLUID
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397073338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.64
|
| Rate for Payer: Aetna Medicare Advantage |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.00
|
| 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 |
$43.32
|
| Rate for Payer: Cigna Commercial |
$119.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.00
|
| Rate for Payer: Clover Medicare Advantage |
$11.40
|
| Rate for Payer: EmblemHealth Commercial |
$36.00
|
| Rate for Payer: Humana Medicare Advantage |
$12.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.33
|
|
|
CH C4 FLUID
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397073338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$35.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.85
|
|
|
CH C7
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397073565
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$46.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.20
|
|
|
CH C7
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397073565
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna Commercial |
$32.64
|
| Rate for Payer: Aetna Medicare Advantage |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.00
|
| 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 |
$43.32
|
| Rate for Payer: Cigna Commercial |
$154.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.00
|
| Rate for Payer: Clover Medicare Advantage |
$11.40
|
| Rate for Payer: EmblemHealth Commercial |
$36.00
|
| Rate for Payer: Humana Medicare Advantage |
$12.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$92.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.16
|
|
|
CH CA 125
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
397073117
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$32.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.10
|
|
|
CH CA 125
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
397073117
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.67 |
| 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 |
$22.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.12
|
| Rate for Payer: Cigna Commercial |
$107.00
|
| 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 |
$64.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.10
|
| 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 |
$5.67
|
|
|
CH CA125 FLUID
|
Facility
|
IP
|
$261.65
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
397073216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$39.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.25
|
|
|
CH CA125 FLUID
|
Facility
|
OP
|
$261.65
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
397073216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$130.82 |
| 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 |
$22.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.12
|
| Rate for Payer: Cigna Commercial |
$130.82
|
| 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 |
$78.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.25
|
| 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 |
$6.93
|
|
|
CH CA 15-3
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
397072002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$53.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.12
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| 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 |
$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 |
$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 |
$10.34
|
|
|
CH CA 15-3
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
397072002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH CA 19-9
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
397072001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.34 |
| 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 |
$22.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.12
|
| Rate for Payer: Cigna Commercial |
$63.00
|
| 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 |
$37.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.90
|
| 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 |
$3.34
|
|
|
CH CA 19-9
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
397072001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.90
|
|
|
CH CA 27-29
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
397073212
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$22.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.35
|
|
|
CH CA 27-29
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
397073212
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.95 |
| 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 |
$53.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.12
|
| Rate for Payer: Cigna Commercial |
$74.50
|
| 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 |
$44.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.35
|
| 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 |
$3.95
|
|
|
CH CADMIUM BLOOD
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 82300
|
| Hospital Charge Code |
397073052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
CH CADMIUM BLOOD
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 82300
|
| Hospital Charge Code |
397073052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$64.30
|
| Rate for Payer: Aetna Medicare Advantage |
$76.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$85.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$85.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$85.33
|
| Rate for Payer: Cigna Commercial |
$86.50
|
| Rate for Payer: Cigna Medicare Advantage |
$23.64
|
| Rate for Payer: Clover Medicare Advantage |
$22.46
|
| Rate for Payer: EmblemHealth Commercial |
$70.92
|
| Rate for Payer: Humana Medicare Advantage |
$24.35
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$23.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$51.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$23.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.58
|
|
|
CH CADMIUM URINE
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
HCPCS 82300
|
| Hospital Charge Code |
397072037
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$64.30
|
| Rate for Payer: Aetna Medicare Advantage |
$76.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$85.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$85.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$85.33
|
| Rate for Payer: Cigna Commercial |
$304.00
|
| Rate for Payer: Cigna Medicare Advantage |
$23.64
|
| Rate for Payer: Clover Medicare Advantage |
$22.46
|
| Rate for Payer: EmblemHealth Commercial |
$70.92
|
| Rate for Payer: Humana Medicare Advantage |
$24.35
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$23.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$182.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$23.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.11
|
|
|
CH CADMIUM URINE
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
HCPCS 82300
|
| Hospital Charge Code |
397072037
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.20
|
|
