|
CHEST ONE VIEW PORTABLE
|
Facility
|
OP
|
$6,095.93
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
2003069
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$281.22
|
| Rate for Payer: Aetna Medicare Advantage |
$334.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$373.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$373.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$103.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$373.21
|
| Rate for Payer: Cigna Commercial |
$207.24
|
| Rate for Payer: Cigna Medicare Advantage |
$72.37
|
| Rate for Payer: Clover Medicare Advantage |
$98.22
|
| Rate for Payer: EmblemHealth Commercial |
$310.17
|
| Rate for Payer: Humana Medicare Advantage |
$106.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$103.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,828.78
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$914.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$146.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$161.54
|
|
|
CHEST ONE VIEW PORTABLE
|
Facility
|
IP
|
$6,095.93
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
2003069
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$914.39 |
| Max. Negotiated Rate |
$914.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$914.39
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$5,923.94
|
|
|
Service Code
|
APR-DRG 2031
|
| Min. Negotiated Rate |
$5,807.78 |
| Max. Negotiated Rate |
$5,923.94 |
| Rate for Payer: UnitedHealthcare Community & State |
$5,807.78
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$5,923.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5,807.78
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$25,405.72
|
|
|
Service Code
|
MSDRG 313
|
| Min. Negotiated Rate |
$7,735.72 |
| Max. Negotiated Rate |
$25,405.72 |
| Rate for Payer: Aetna Commercial |
$17,713.96
|
| Rate for Payer: Aetna Medicare Advantage |
$25,405.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16,747.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16,747.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8,142.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16,747.92
|
| Rate for Payer: Cigna Commercial |
$13,474.08
|
| Rate for Payer: Cigna Medicare Advantage |
$8,142.86
|
| Rate for Payer: Clover Medicare Advantage |
$7,735.72
|
| Rate for Payer: EmblemHealth Commercial |
$24,428.58
|
| Rate for Payer: Humana Medicare Advantage |
$8,387.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8,142.86
|
| Rate for Payer: Oxford Commercial |
$9,684.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,981.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8,142.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$8,142.86
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$14,249.35
|
|
|
Service Code
|
APR-DRG 2034
|
| Min. Negotiated Rate |
$13,969.95 |
| Max. Negotiated Rate |
$14,249.35 |
| Rate for Payer: UnitedHealthcare Community & State |
$13,969.95
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$14,249.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13,969.95
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$7,029.57
|
|
|
Service Code
|
APR-DRG 2032
|
| Min. Negotiated Rate |
$6,891.74 |
| Max. Negotiated Rate |
$7,029.57 |
| Rate for Payer: UnitedHealthcare Community & State |
$6,891.74
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$7,029.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6,891.74
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$8,843.79
|
|
|
Service Code
|
APR-DRG 2033
|
| Min. Negotiated Rate |
$8,670.38 |
| Max. Negotiated Rate |
$8,843.79 |
| Rate for Payer: UnitedHealthcare Community & State |
$8,670.38
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$8,843.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8,670.38
|
|
|
CHEST PHYSIOTHERAPY SUBSEQUENT
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 94668
|
| Hospital Charge Code |
9500555
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
CHEST PHYSIOTHERAPY SUBSEQUENT
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 94668
|
| Hospital Charge Code |
9500555
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$81.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.55
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.40
|
| Rate for Payer: Oxford Commercial |
$885.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.08
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
|
CHEST PHY THERAPY MULTI***
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
9500562
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.80
|
|
|
CHEST PHY THERAPY MULTI***
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
9500562
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$151.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.55
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.60
|
| Rate for Payer: Oxford Commercial |
$885.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.50
|
|
|
CHEST PT INITIAL OR EVAL
|
Facility
|
OP
|
$178.45
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
9500554
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$151.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.55
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.53
|
| Rate for Payer: Oxford Commercial |
$885.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.73
|
|
|
CHEST PT INITIAL OR EVAL
|
Facility
|
IP
|
$178.45
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
9500554
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.77
|
|
|
CH ESTRADIOL E2
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
397072061
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$100.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$100.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$27.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$100.86
|
| Rate for Payer: Cigna Commercial |
$225.00
|
| Rate for Payer: Cigna Medicare Advantage |
$27.94
|
| Rate for Payer: Clover Medicare Advantage |
$26.54
|
| Rate for Payer: EmblemHealth Commercial |
$83.82
|
| Rate for Payer: Humana Medicare Advantage |
$28.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$27.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$27.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.93
|
|
|
CH ESTRADIOL E2
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
397072061
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
|
|
CH ESTRIOL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
397073241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH ESTRIOL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
397073241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$65.77
|
| Rate for Payer: Aetna Medicare Advantage |
$78.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.28
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.18
|
| Rate for Payer: Clover Medicare Advantage |
$22.97
|
| Rate for Payer: EmblemHealth Commercial |
$72.54
|
| Rate for Payer: Humana Medicare Advantage |
$24.91
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.18
|
| 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 |
$19.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH ESTRIOL E3
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
397071006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$65.77
|
| Rate for Payer: Aetna Medicare Advantage |
$78.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.28
|
| Rate for Payer: Cigna Commercial |
$99.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.18
|
| Rate for Payer: Clover Medicare Advantage |
$22.97
|
| Rate for Payer: EmblemHealth Commercial |
$72.54
|
| Rate for Payer: Humana Medicare Advantage |
$24.91
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.25
|
|
|
CH ESTRIOL E3
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
397071006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
|
|
CH ESTROGEN FRACTION S
|
Facility
|
IP
|
$767.00
|
|
|
Service Code
|
HCPCS 82671
|
| Hospital Charge Code |
397072064
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.05 |
| Max. Negotiated Rate |
$115.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.05
|
|
|
CH ESTROGEN FRACTION S
|
Facility
|
OP
|
$767.00
|
|
|
Service Code
|
HCPCS 82671
|
| Hospital Charge Code |
397072064
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$383.50 |
| Rate for Payer: Aetna Commercial |
$87.86
|
| Rate for Payer: Aetna Medicare Advantage |
$104.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$116.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$116.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$32.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$116.59
|
| Rate for Payer: Cigna Commercial |
$383.50
|
| Rate for Payer: Cigna Medicare Advantage |
$32.30
|
| Rate for Payer: Clover Medicare Advantage |
$30.68
|
| Rate for Payer: EmblemHealth Commercial |
$96.90
|
| Rate for Payer: Humana Medicare Advantage |
$33.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$32.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$32.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.33
|
|
|
CH ESTROGEN PROGESTERON
|
Facility
|
OP
|
$1,637.65
|
|
|
Service Code
|
HCPCS 84233
|
| Hospital Charge Code |
397061019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.07 |
| Max. Negotiated Rate |
$818.83 |
| Rate for Payer: Aetna Commercial |
$239.03
|
| Rate for Payer: Aetna Medicare Advantage |
$284.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$317.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$317.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$87.88
|
| 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 |
$317.22
|
| Rate for Payer: Cigna Commercial |
$818.83
|
| Rate for Payer: Cigna Medicare Advantage |
$87.88
|
| Rate for Payer: Clover Medicare Advantage |
$83.49
|
| Rate for Payer: EmblemHealth Commercial |
$263.64
|
| Rate for Payer: Humana Medicare Advantage |
$90.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$87.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$491.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$245.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$70.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$87.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.40
|
|
|
CH ESTROGEN PROGESTERON
|
Facility
|
IP
|
$1,637.65
|
|
|
Service Code
|
HCPCS 84233
|
| Hospital Charge Code |
397061019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$245.65 |
| Max. Negotiated Rate |
$245.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$245.65
|
|
|
CH ESTROGEN TOTAL
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
HCPCS 82672
|
| Hospital Charge Code |
397073011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$59.02
|
| Rate for Payer: Aetna Medicare Advantage |
$70.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.33
|
| Rate for Payer: Cigna Commercial |
$212.00
|
| Rate for Payer: Cigna Medicare Advantage |
$21.70
|
| Rate for Payer: Clover Medicare Advantage |
$20.61
|
| Rate for Payer: EmblemHealth Commercial |
$65.10
|
| Rate for Payer: Humana Medicare Advantage |
$22.35
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.24
|
|
|
CH ESTROGEN TOTAL
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS 82672
|
| Hospital Charge Code |
397073011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.60
|
|
