|
CH DIRECT COOMBS (DAT)
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
397031026
|
|
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 DISOPYRAMIDE
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397072058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.45
|
|
|
CH DISOPYRAMIDE
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397072058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.85 |
| 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 |
$91.50
|
| 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 |
$54.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.45
|
| 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 |
$4.85
|
|
|
CH DNASE-B AB
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
HCPCS 86215
|
| Hospital Charge Code |
397071549
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$36.04
|
| Rate for Payer: Aetna Medicare Advantage |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.83
|
| Rate for Payer: Cigna Commercial |
$106.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.25
|
| Rate for Payer: Clover Medicare Advantage |
$12.59
|
| Rate for Payer: EmblemHealth Commercial |
$39.75
|
| Rate for Payer: Humana Medicare Advantage |
$13.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.64
|
|
|
CH DNASE-B AB
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
HCPCS 86215
|
| Hospital Charge Code |
397071549
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$31.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.95
|
|
|
CH DOG EPITHELIA IGE
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397073669
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.22
|
| 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 |
$18.84
|
| Rate for Payer: Cigna Commercial |
$16.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.22
|
| Rate for Payer: Clover Medicare Advantage |
$4.96
|
| Rate for Payer: EmblemHealth Commercial |
$15.66
|
| Rate for Payer: Humana Medicare Advantage |
$5.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.22
|
| 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 |
$4.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.85
|
|
|
CH DOG EPITHELIA IGE
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397073669
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.80
|
|
|
CH DOXEPIN
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
397072059
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$38.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.10
|
|
|
CH DOXEPIN
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
397072059
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Aetna Commercial |
$96.52
|
| Rate for Payer: Aetna Medicare Advantage |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.77
|
| Rate for Payer: Cigna Commercial |
$127.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.73
|
|
|
CH DRUG CONFIRMATION
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 80102
|
| Hospital Charge Code |
397071032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$156.50 |
| Rate for Payer: Aetna Commercial |
$118.94
|
| Rate for Payer: Aetna Medicare Advantage |
$93.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.81
|
| Rate for Payer: Cigna Commercial |
$156.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.29
|
|
|
CH DRUG CONFIRMATION
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 80102
|
| Hospital Charge Code |
397071032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$46.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.95
|
|
|
CH DRVVT SCREEN W/REFLEX
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
397071543
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH DRVVT SCREEN W/REFLEX
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
397071543
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$26.06
|
| Rate for Payer: Aetna Medicare Advantage |
$31.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.58
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$9.58
|
| Rate for Payer: Clover Medicare Advantage |
$9.10
|
| Rate for Payer: EmblemHealth Commercial |
$28.74
|
| Rate for Payer: Humana Medicare Advantage |
$9.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.58
|
| 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 |
$7.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH DU TEST
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 86885
|
| Hospital Charge Code |
397031060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$405.73 |
| Rate for Payer: Aetna Commercial |
$15.56
|
| Rate for Payer: Aetna Medicare Advantage |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.65
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$5.72
|
| Rate for Payer: Clover Medicare Advantage |
$5.43
|
| Rate for Payer: EmblemHealth Commercial |
$17.16
|
| Rate for Payer: Humana Medicare Advantage |
$5.89
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.72
|
| 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 |
$4.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
CH DU TEST
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 86885
|
| Hospital Charge Code |
397031060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
|
|
CH D XYLOSE PLASMA
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
HCPCS 84620
|
| Hospital Charge Code |
397071183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna Commercial |
$35.12
|
| Rate for Payer: Aetna Medicare Advantage |
$41.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.60
|
| Rate for Payer: Cigna Commercial |
$198.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.91
|
| Rate for Payer: Clover Medicare Advantage |
$12.26
|
| Rate for Payer: EmblemHealth Commercial |
$38.73
|
| Rate for Payer: Humana Medicare Advantage |
$13.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.49
|
|
|
CH D XYLOSE PLASMA
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
HCPCS 84620
|
| Hospital Charge Code |
397071183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.40
|
|
|
CH D XYLOSE URINE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS 84620
|
| Hospital Charge Code |
397071301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.70
|
|
|
CH D XYLOSE URINE
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS 84620
|
| Hospital Charge Code |
397071301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Aetna Commercial |
$35.12
|
| Rate for Payer: Aetna Medicare Advantage |
$41.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.60
|
| Rate for Payer: Cigna Commercial |
$129.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.91
|
| Rate for Payer: Clover Medicare Advantage |
$12.26
|
| Rate for Payer: EmblemHealth Commercial |
$38.73
|
| Rate for Payer: Humana Medicare Advantage |
$13.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.84
|
|
|
CH EBV,DNA,QI,RT PCR
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
397071389
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$153.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$414.00
|
| Rate for Payer: Cigna Medicare Advantage |
$35.09
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.94
|
|
|
CH EBV,DNA,QI,RT PCR
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
397071389
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.20
|
|
|
CH EBV VIRUS DNA PCR
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
397071097
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.05 |
| Max. Negotiated Rate |
$43.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.05
|
|
|
CH EBV VIRUS DNA PCR
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
397071097
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$153.02 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$153.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$143.50
|
| Rate for Payer: Cigna Medicare Advantage |
$35.09
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$86.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.61
|
|
|
CH E.CHAFFEENSIS AB, LGG,LGM
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
397071403
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$79.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.05
|
|
|
CH E.CHAFFEENSIS AB, LGG,LGM
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
397071403
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: Aetna Commercial |
$27.69
|
| Rate for Payer: Aetna Medicare Advantage |
$32.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.75
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: Cigna Medicare Advantage |
$10.18
|
| Rate for Payer: Clover Medicare Advantage |
$9.67
|
| Rate for Payer: EmblemHealth Commercial |
$30.54
|
| Rate for Payer: Humana Medicare Advantage |
$10.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$158.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.97
|
|
