|
CH CITRIC ACID, SERUM
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
397071501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.75
|
|
|
CH CITRIC ACID, SERUM
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
397071501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$75.62
|
| Rate for Payer: Aetna Medicare Advantage |
$90.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$100.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$100.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$77.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$100.35
|
| Rate for Payer: Cigna Commercial |
$82.50
|
| Rate for Payer: Cigna Medicare Advantage |
$27.80
|
| Rate for Payer: Clover Medicare Advantage |
$26.41
|
| Rate for Payer: EmblemHealth Commercial |
$83.40
|
| Rate for Payer: Humana Medicare Advantage |
$28.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$27.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$27.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.37
|
|
|
CH CK (CPK)
|
Facility
|
IP
|
$385.26
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
397071138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.79 |
| Max. Negotiated Rate |
$57.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.79
|
|
|
CH CK (CPK)
|
Facility
|
OP
|
$385.26
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
397071138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$192.63 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.50
|
| Rate for Payer: Cigna Commercial |
$192.63
|
| Rate for Payer: Cigna Medicare Advantage |
$6.51
|
| Rate for Payer: Clover Medicare Advantage |
$6.18
|
| Rate for Payer: EmblemHealth Commercial |
$19.53
|
| Rate for Payer: Humana Medicare Advantage |
$6.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$115.58
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.21
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.21
|
|
|
CH CK ISOENZYMES
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
397073033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.45
|
|
|
CH CK ISOENZYMES
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
397073255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.45
|
|
|
CH CK ISOENZYMES
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
397073255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$36.42
|
| Rate for Payer: Aetna Medicare Advantage |
$43.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.33
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.39
|
| Rate for Payer: Clover Medicare Advantage |
$12.72
|
| Rate for Payer: EmblemHealth Commercial |
$40.17
|
| Rate for Payer: Humana Medicare Advantage |
$13.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.20
|
|
|
CH CK ISOENZYMES
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
397073033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$36.42
|
| Rate for Payer: Aetna Medicare Advantage |
$43.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.33
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.39
|
| Rate for Payer: Clover Medicare Advantage |
$12.72
|
| Rate for Payer: EmblemHealth Commercial |
$40.17
|
| Rate for Payer: Humana Medicare Advantage |
$13.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.20
|
|
|
CH CKMB
|
Facility
|
OP
|
$807.65
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
397071108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$403.82 |
| Rate for Payer: Aetna Commercial |
$31.42
|
| Rate for Payer: Aetna Medicare Advantage |
$37.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.69
|
| Rate for Payer: Cigna Commercial |
$403.82
|
| Rate for Payer: Cigna Medicare Advantage |
$11.55
|
| Rate for Payer: Clover Medicare Advantage |
$10.97
|
| Rate for Payer: EmblemHealth Commercial |
$34.65
|
| Rate for Payer: Humana Medicare Advantage |
$11.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.29
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$121.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.40
|
|
|
CH CKMB
|
Facility
|
IP
|
$807.65
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
397071108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$121.15 |
| Max. Negotiated Rate |
$121.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$121.15
|
|
|
CH CK W/MB FRACT RFX
|
Facility
|
IP
|
$385.26
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
397073627
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.79 |
| Max. Negotiated Rate |
$57.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.79
|
|
|
CH CK W/MB FRACT RFX
|
Facility
|
OP
|
$385.26
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
397073627
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$192.63 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.50
|
| Rate for Payer: Cigna Commercial |
$192.63
|
| Rate for Payer: Cigna Medicare Advantage |
$6.51
|
| Rate for Payer: Clover Medicare Advantage |
$6.18
|
| Rate for Payer: EmblemHealth Commercial |
$19.53
|
| Rate for Payer: Humana Medicare Advantage |
$6.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$115.58
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.21
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.21
|
|
|
CH CLOMIPRAMINE
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
397072006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Medicare Advantage |
$78.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.09
|
| 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 |
$86.96
|
| Rate for Payer: Cigna Commercial |
$54.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.09
|
| Rate for Payer: Clover Medicare Advantage |
$22.89
|
| Rate for Payer: EmblemHealth Commercial |
$72.27
|
| Rate for Payer: Humana Medicare Advantage |
$24.81
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.86
|
|
|
CH CLOMIPRAMINE
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
397072006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.20
|
|
|
CH CLONAZEPAM
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
397072047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.10
|
|
|
CH CLONAZEPAM
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
397072047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$43.32
|
| Rate for Payer: Aetna Medicare Advantage |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.07
|
| Rate for Payer: Cigna Commercial |
$57.00
|
| 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 |
$20.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.02
|
|
|
CH CLONIDINE
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
397072048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.20
|
|
|
CH CLONIDINE
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
397072048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Medicare Advantage |
$78.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.09
|
| 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 |
$86.96
|
| Rate for Payer: Cigna Commercial |
$114.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.09
|
| Rate for Payer: Clover Medicare Advantage |
$22.89
|
| Rate for Payer: EmblemHealth Commercial |
$72.27
|
| Rate for Payer: Humana Medicare Advantage |
$24.81
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$68.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.04
|
|
|
CH CLOT RETRACTION
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 85170
|
| Hospital Charge Code |
397021083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.65
|
|
|
CH CLOT RETRACTION
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 85170
|
| Hospital Charge Code |
397021083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$44.34
|
| Rate for Payer: Aetna Medicare Advantage |
$52.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.84
|
| Rate for Payer: Cigna Commercial |
$65.50
|
| Rate for Payer: Cigna Medicare Advantage |
$16.30
|
| Rate for Payer: Clover Medicare Advantage |
$15.48
|
| Rate for Payer: EmblemHealth Commercial |
$48.90
|
| Rate for Payer: Humana Medicare Advantage |
$16.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.47
|
|
|
CH CLOTTING TIME
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 85348
|
| Hospital Charge Code |
397021079
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
|
|
CH CLOTTING TIME
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 85348
|
| Hospital Charge Code |
397021079
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Medicare Advantage |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.21
|
| Rate for Payer: Cigna Commercial |
$40.50
|
| Rate for Payer: Cigna Medicare Advantage |
$4.49
|
| Rate for Payer: Clover Medicare Advantage |
$4.27
|
| Rate for Payer: EmblemHealth Commercial |
$13.47
|
| Rate for Payer: Humana Medicare Advantage |
$4.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
CH CLOZAPINE
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.75
|
|
|
CH CLOZAPINE
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$50.70
|
| Rate for Payer: Aetna Medicare Advantage |
$60.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.28
|
| Rate for Payer: Cigna Commercial |
$102.50
|
| Rate for Payer: Cigna Medicare Advantage |
$18.64
|
| Rate for Payer: Clover Medicare Advantage |
$17.71
|
| Rate for Payer: EmblemHealth Commercial |
$55.92
|
| Rate for Payer: Humana Medicare Advantage |
$19.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.43
|
|
|
CH CMV IGG AB CSF
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
397071091
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.20
|
|
