|
CH COMPL C1 Q
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397072050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| 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 |
$80.50
|
| 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 |
$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 |
$9.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.27
|
|
|
CH COMPL C1 Q
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397072050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.15
|
|
|
CH COMPLEMENT C1Q
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397071336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.50
|
|
|
CH COMPLEMENT C1Q
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397071336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| 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 |
$85.00
|
| 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 |
$51.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.50
|
| 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 |
$4.50
|
|
|
CH COMPLEMENT C2
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397072051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
|
|
CH COMPLEMENT C2
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397072051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.15 |
| 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 |
$40.50
|
| 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 |
$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 |
$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 |
$2.15
|
|
|
CH COMPLEMENT C3
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397071058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.39 |
| 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 |
$64.00
|
| 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 |
$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 |
$9.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
|
CH COMPLEMENT C3
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397071058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
CH COMPLEMENT C4
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397071305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.39 |
| 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 |
$64.00
|
| 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 |
$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 |
$9.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
|
CH COMPLEMENT C4
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397071305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
CH COMPLEMENT TOTAL CH100
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 86162
|
| Hospital Charge Code |
397073008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Aetna Commercial |
$55.27
|
| Rate for Payer: Aetna Medicare Advantage |
$65.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$73.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$73.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$73.35
|
| Rate for Payer: Cigna Commercial |
$146.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.32
|
| Rate for Payer: Clover Medicare Advantage |
$19.30
|
| Rate for Payer: EmblemHealth Commercial |
$60.96
|
| Rate for Payer: Humana Medicare Advantage |
$20.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$87.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.74
|
|
|
CH COMPLEMENT TOTAL CH100
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 86162
|
| Hospital Charge Code |
397073008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$43.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.80
|
|
|
CH COMPLEM TOTAL CH50
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 86162
|
| Hospital Charge Code |
397071210
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.90
|
|
|
CH COMPLEM TOTAL CH50
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 86162
|
| Hospital Charge Code |
397071210
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$55.27
|
| Rate for Payer: Aetna Medicare Advantage |
$65.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$73.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$73.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$73.35
|
| Rate for Payer: Cigna Commercial |
$63.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.32
|
| Rate for Payer: Clover Medicare Advantage |
$19.30
|
| Rate for Payer: EmblemHealth Commercial |
$60.96
|
| Rate for Payer: Humana Medicare Advantage |
$20.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.32
|
| 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 |
$16.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.34
|
|
|
CH COMPREHENSIVE HLA ABC/DR
|
Facility
|
OP
|
$1,382.00
|
|
|
Service Code
|
HCPCS 86813
|
| Hospital Charge Code |
397031077
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Aetna Commercial |
$157.76
|
| Rate for Payer: Aetna Medicare Advantage |
$187.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$209.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$209.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$209.36
|
| Rate for Payer: Cigna Commercial |
$691.00
|
| Rate for Payer: Cigna Medicare Advantage |
$58.00
|
| Rate for Payer: Clover Medicare Advantage |
$55.10
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Humana Medicare Advantage |
$59.74
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$58.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$414.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$207.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$58.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$58.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.62
|
|
|
CH COMPREHENSIVE HLA ABC/DR
|
Facility
|
IP
|
$1,382.00
|
|
|
Service Code
|
HCPCS 86813
|
| Hospital Charge Code |
397031077
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$207.30 |
| Max. Negotiated Rate |
$207.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$207.30
|
|
|
CH CONCENTRATION
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
397073656
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.30
|
|
|
CH CONCENTRATION
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
397073656
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$18.17
|
| Rate for Payer: Aetna Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.11
|
| Rate for Payer: Cigna Commercial |
$21.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.68
|
| Rate for Payer: Clover Medicare Advantage |
$6.35
|
| Rate for Payer: EmblemHealth Commercial |
$20.04
|
| Rate for Payer: Humana Medicare Advantage |
$6.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.11
|
|
|
CH COOMBS C3B
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
397031013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$140.48 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Medicare Advantage |
$17.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.46
|
| Rate for Payer: Cigna Commercial |
$140.48
|
| Rate for Payer: Cigna Medicare Advantage |
$5.39
|
| Rate for Payer: Clover Medicare Advantage |
$5.12
|
| Rate for Payer: EmblemHealth Commercial |
$16.17
|
| Rate for Payer: Humana Medicare Advantage |
$5.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.56
|
|
|
CH COOMBS C3B
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
397031013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.85
|
|
|
CH COOMBS C3D
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
397031011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$140.48 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Medicare Advantage |
$17.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.46
|
| Rate for Payer: Cigna Commercial |
$140.48
|
| Rate for Payer: Cigna Medicare Advantage |
$5.39
|
| Rate for Payer: Clover Medicare Advantage |
$5.12
|
| Rate for Payer: EmblemHealth Commercial |
$16.17
|
| Rate for Payer: Humana Medicare Advantage |
$5.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.39
|
| 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 |
$4.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
CH COOMBS C3D
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
397031011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
|
|
CH COOMBS IGG
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
397031018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$140.48 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Medicare Advantage |
$17.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.46
|
| Rate for Payer: Cigna Commercial |
$140.48
|
| Rate for Payer: Cigna Medicare Advantage |
$5.39
|
| Rate for Payer: Clover Medicare Advantage |
$5.12
|
| Rate for Payer: EmblemHealth Commercial |
$16.17
|
| Rate for Payer: Humana Medicare Advantage |
$5.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.39
|
| 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 |
$4.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH COOMBS IGG
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
397031018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH COPPER SERUM
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 82525
|
| Hospital Charge Code |
397072053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$33.76
|
| Rate for Payer: Aetna Medicare Advantage |
$40.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.41
|
| 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 |
$44.80
|
| Rate for Payer: Cigna Commercial |
$55.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.41
|
| Rate for Payer: Clover Medicare Advantage |
$11.79
|
| Rate for Payer: EmblemHealth Commercial |
$37.23
|
| Rate for Payer: Humana Medicare Advantage |
$12.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.93
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.94
|
|
