|
CH CU INDEX TM
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS 86343
|
| Hospital Charge Code |
397073673
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna Commercial |
$33.89
|
| Rate for Payer: Aetna Medicare Advantage |
$40.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.98
|
| Rate for Payer: Cigna Commercial |
$335.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.46
|
| Rate for Payer: Clover Medicare Advantage |
$11.84
|
| Rate for Payer: EmblemHealth Commercial |
$37.38
|
| Rate for Payer: Humana Medicare Advantage |
$12.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.97
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.75
|
|
|
CH CULT BLD-TIMED 30MIN APAR
|
Facility
|
OP
|
$148.87
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
397041233
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$28.07
|
| Rate for Payer: Aetna Medicare Advantage |
$33.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.32
|
| 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 |
$37.25
|
| Rate for Payer: Cigna Commercial |
$74.44
|
| Rate for Payer: Cigna Medicare Advantage |
$10.32
|
| Rate for Payer: Clover Medicare Advantage |
$9.80
|
| Rate for Payer: EmblemHealth Commercial |
$30.96
|
| Rate for Payer: Humana Medicare Advantage |
$10.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.66
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.95
|
|
|
CH CULT BLD-TIMED 30MIN APAR
|
Facility
|
IP
|
$148.87
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
397041233
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$22.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.33
|
|
|
CH CULTURE AFB
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
397041024
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Medicare Advantage |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.80
|
| 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 |
$38.98
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.80
|
| Rate for Payer: Clover Medicare Advantage |
$10.26
|
| Rate for Payer: EmblemHealth Commercial |
$32.40
|
| Rate for Payer: Humana Medicare Advantage |
$11.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.80
|
| 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 |
$8.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH CULTURE AFB
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
397041024
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH CULTURE AMNIOTIC FLUID
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397041278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.62
|
| 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 |
$31.12
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.62
|
| Rate for Payer: Clover Medicare Advantage |
$8.19
|
| Rate for Payer: EmblemHealth Commercial |
$25.86
|
| Rate for Payer: Humana Medicare Advantage |
$8.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.62
|
| 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 |
$6.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH CULTURE AMNIOTIC FLUID
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397041278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH CULTURE ANAEROBIC
|
Facility
|
IP
|
$179.25
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
397041248
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$26.89 |
| Max. Negotiated Rate |
$26.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.89
|
|
|
CH CULTURE ANAEROBIC
|
Facility
|
OP
|
$179.25
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
397041248
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$25.76
|
| Rate for Payer: Aetna Medicare Advantage |
$30.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.47
|
| 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 |
$34.18
|
| Rate for Payer: Cigna Commercial |
$89.62
|
| Rate for Payer: Cigna Medicare Advantage |
$9.47
|
| Rate for Payer: Clover Medicare Advantage |
$9.00
|
| Rate for Payer: EmblemHealth Commercial |
$28.41
|
| Rate for Payer: Humana Medicare Advantage |
$9.75
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.77
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.75
|
|
|
CH CULTURE BODY FLUIDS
|
Facility
|
OP
|
$93.65
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397041018
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.62
|
| 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 |
$31.12
|
| Rate for Payer: Cigna Commercial |
$46.83
|
| Rate for Payer: Cigna Medicare Advantage |
$8.62
|
| Rate for Payer: Clover Medicare Advantage |
$8.19
|
| Rate for Payer: EmblemHealth Commercial |
$25.86
|
| Rate for Payer: Humana Medicare Advantage |
$8.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.09
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.48
|
|
|
CH CULTURE BODY FLUIDS
|
Facility
|
IP
|
$93.65
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397041018
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
|
|
CH CULTURE BRONCHIAL
|
Facility
|
IP
|
$93.65
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397041277
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
|
|
CH CULTURE BRONCHIAL
|
Facility
|
OP
|
$93.65
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397041277
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.62
|
| 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 |
$31.12
|
| Rate for Payer: Cigna Commercial |
$46.83
|
| Rate for Payer: Cigna Medicare Advantage |
$8.62
|
| Rate for Payer: Clover Medicare Advantage |
$8.19
|
| Rate for Payer: EmblemHealth Commercial |
$25.86
|
| Rate for Payer: Humana Medicare Advantage |
$8.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.09
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.48
|
|
|
CH CULTURE CATH TIP
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397040071
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH CULTURE CATH TIP
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397040071
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.62
|
| 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 |
$31.12
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.62
|
| Rate for Payer: Clover Medicare Advantage |
$8.19
|
| Rate for Payer: EmblemHealth Commercial |
$25.86
|
| Rate for Payer: Humana Medicare Advantage |
$8.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.62
|
| 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 |
$6.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH CULTURE EYE
|
Facility
|
IP
|
$93.65
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397041046
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
|
|
CH CULTURE EYE
|
Facility
|
OP
|
$93.65
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397041046
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.62
|
| 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 |
$31.12
|
| Rate for Payer: Cigna Commercial |
$46.83
|
| Rate for Payer: Cigna Medicare Advantage |
$8.62
|
| Rate for Payer: Clover Medicare Advantage |
$8.19
|
| Rate for Payer: EmblemHealth Commercial |
$25.86
|
| Rate for Payer: Humana Medicare Advantage |
$8.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.09
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.48
|
|
|
CH CULTURE FUNGUS
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 87102
|
| Hospital Charge Code |
397041005
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$22.88
|
| Rate for Payer: Aetna Medicare Advantage |
$27.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.36
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.41
|
| Rate for Payer: Clover Medicare Advantage |
$7.99
|
| Rate for Payer: EmblemHealth Commercial |
$25.23
|
| Rate for Payer: Humana Medicare Advantage |
$8.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.08
|
|
|
CH CULTURE FUNGUS
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 87102
|
| Hospital Charge Code |
397041005
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
CH CULTURE GC
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
397041022
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH CULTURE GC
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
397041022
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$195.00
|
| 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 |
$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 |
$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 |
$10.34
|
|
|
CH CULTURE GENITAL
|
Facility
|
OP
|
$93.65
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397041007
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.62
|
| 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 |
$31.12
|
| Rate for Payer: Cigna Commercial |
$46.83
|
| Rate for Payer: Cigna Medicare Advantage |
$8.62
|
| Rate for Payer: Clover Medicare Advantage |
$8.19
|
| Rate for Payer: EmblemHealth Commercial |
$25.86
|
| Rate for Payer: Humana Medicare Advantage |
$8.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.09
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.48
|
|
|
CH CULTURE GENITAL
|
Facility
|
IP
|
$93.65
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397041007
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
|
|
CH CULTURE GROUP B SCREEN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
397041320
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$195.00
|
| 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 |
$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 |
$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 |
$10.34
|
|
|
CH CULTURE GROUP B SCREEN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
397041320
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
