|
CH CALCITONIN
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
397071218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$72.87
|
| Rate for Payer: Aetna Medicare Advantage |
$86.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$96.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$96.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$65.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$96.70
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: Cigna Medicare Advantage |
$26.79
|
| Rate for Payer: Clover Medicare Advantage |
$25.45
|
| Rate for Payer: EmblemHealth Commercial |
$80.37
|
| Rate for Payer: Humana Medicare Advantage |
$27.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$26.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.43
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.51
|
|
|
CH CALCITONIN
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
397071218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.20
|
|
|
CH CALCIUM
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
397071090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.80
|
|
|
CH CALCIUM
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
397071090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna Medicare Advantage |
$16.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.63
|
| Rate for Payer: Cigna Commercial |
$16.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.16
|
| Rate for Payer: Clover Medicare Advantage |
$4.90
|
| Rate for Payer: EmblemHealth Commercial |
$15.48
|
| Rate for Payer: Humana Medicare Advantage |
$5.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.85
|
|
|
CH CALCIUM CHANNEL BLOCKER
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397071300
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.80
|
|
|
CH CALCIUM CHANNEL BLOCKER
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397071300
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Aetna Medicare Advantage |
$59.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.42
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.40
|
| Rate for Payer: Clover Medicare Advantage |
$17.48
|
| Rate for Payer: EmblemHealth Commercial |
$55.20
|
| Rate for Payer: Humana Medicare Advantage |
$18.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$105.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.33
|
|
|
CH CALCIUM-IONIZED
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
397071273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
|
|
CH CALCIUM-IONIZED
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
397071273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$37.21
|
| Rate for Payer: Aetna Medicare Advantage |
$44.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.38
|
| Rate for Payer: Cigna Commercial |
$33.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.68
|
| Rate for Payer: Clover Medicare Advantage |
$13.00
|
| Rate for Payer: EmblemHealth Commercial |
$41.04
|
| Rate for Payer: Humana Medicare Advantage |
$14.09
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.94
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.75
|
|
|
CH CALCIUM (RANDOM)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
397073110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna Medicare Advantage |
$16.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.63
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.16
|
| Rate for Payer: Clover Medicare Advantage |
$4.90
|
| Rate for Payer: EmblemHealth Commercial |
$15.48
|
| Rate for Payer: Humana Medicare Advantage |
$5.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.16
|
| 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 |
$4.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH CALCIUM (RANDOM)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
397073110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH CALCIUM RAND UR (W/CREAT)
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
397073638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna Medicare Advantage |
$16.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.63
|
| Rate for Payer: Cigna Commercial |
$18.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.16
|
| Rate for Payer: Clover Medicare Advantage |
$4.90
|
| Rate for Payer: EmblemHealth Commercial |
$15.48
|
| Rate for Payer: Humana Medicare Advantage |
$5.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.95
|
|
|
CH CALCIUM RAND UR (W/CREAT)
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
397073638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.40
|
|
|
CH CALCIUM URINE 24 HR
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
397071042
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.10
|
|
|
CH CALCIUM URINE 24 HR
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
397071042
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$16.40
|
| Rate for Payer: Aetna Medicare Advantage |
$19.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.03
|
| 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 |
$21.77
|
| Rate for Payer: Cigna Commercial |
$57.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.03
|
| Rate for Payer: Clover Medicare Advantage |
$5.73
|
| Rate for Payer: EmblemHealth Commercial |
$18.09
|
| Rate for Payer: Humana Medicare Advantage |
$6.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.03
|
| 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 |
$4.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.02
|
|
|
CH CANNABINOID CONF
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 80349
|
| Hospital Charge Code |
397073062
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$120.84
|
| Rate for Payer: Aetna Medicare Advantage |
$95.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$81.09
|
| Rate for Payer: Cigna Commercial |
$159.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$95.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.43
|
|
|
CH CANNABINOID CONF
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
HCPCS 80349
|
| Hospital Charge Code |
397073062
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.70
|
|
|
CH CARBAMAZEPINE
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS 80156
|
| Hospital Charge Code |
397071283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$42.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.60
|
|
|
CH CARBAMAZEPINE
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS 80156
|
| Hospital Charge Code |
397071283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: Aetna Commercial |
$39.63
|
| Rate for Payer: Aetna Medicare Advantage |
$47.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.57
|
| 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 |
$52.59
|
| Rate for Payer: Cigna Commercial |
$142.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.57
|
| Rate for Payer: Clover Medicare Advantage |
$13.84
|
| Rate for Payer: EmblemHealth Commercial |
$43.71
|
| Rate for Payer: Humana Medicare Advantage |
$15.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.53
|
|
|
CH CARBAMAZEPINE-10,11 EPOX
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
397071535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$65.58
|
| Rate for Payer: Aetna Medicare Advantage |
$78.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.03
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: Cigna Medicare Advantage |
$24.11
|
| Rate for Payer: Clover Medicare Advantage |
$22.90
|
| Rate for Payer: EmblemHealth Commercial |
$72.33
|
| Rate for Payer: Humana Medicare Advantage |
$24.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.96
|
|
|
CH CARBAMAZEPINE-10,11 EPOX
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
397071535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$28.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.05
|
|
|
CH CARBON MONOXIDE
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
397072040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$155.50 |
| Rate for Payer: Aetna Commercial |
$33.51
|
| Rate for Payer: Aetna Medicare Advantage |
$39.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.32
|
| 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 |
$44.47
|
| Rate for Payer: Cigna Commercial |
$155.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.32
|
| Rate for Payer: Clover Medicare Advantage |
$11.70
|
| Rate for Payer: EmblemHealth Commercial |
$36.96
|
| Rate for Payer: Humana Medicare Advantage |
$12.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.24
|
|
|
CH CARBON MONOXIDE
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
397072040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$46.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.65
|
|
|
CH CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
397071514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$33.51
|
| Rate for Payer: Aetna Medicare Advantage |
$39.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.32
|
| 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 |
$44.47
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.32
|
| Rate for Payer: Clover Medicare Advantage |
$11.70
|
| Rate for Payer: EmblemHealth Commercial |
$36.96
|
| Rate for Payer: Humana Medicare Advantage |
$12.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.32
|
| 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 |
$9.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
397071514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH CARNITINE
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
397073598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$62.51
|
| Rate for Payer: Aetna Medicare Advantage |
$74.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.95
|
| Rate for Payer: Cigna Commercial |
$52.50
|
| Rate for Payer: Cigna Medicare Advantage |
$22.98
|
| Rate for Payer: Clover Medicare Advantage |
$21.83
|
| Rate for Payer: EmblemHealth Commercial |
$68.94
|
| Rate for Payer: Humana Medicare Advantage |
$23.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.78
|
|
