|
CH FACTOR IX
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
397071190
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$51.79
|
| Rate for Payer: Aetna Medicare Advantage |
$61.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.73
|
| Rate for Payer: Cigna Commercial |
$121.00
|
| Rate for Payer: Cigna Medicare Advantage |
$19.04
|
| Rate for Payer: Clover Medicare Advantage |
$18.09
|
| Rate for Payer: EmblemHealth Commercial |
$57.12
|
| Rate for Payer: Humana Medicare Advantage |
$19.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.41
|
|
|
CH FACTOR IX
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
397071190
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.30
|
|
|
CH FACTOR V
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
397071196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.75
|
|
|
CH FACTOR V
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
397071196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.01
|
| Rate for Payer: Aetna Medicare Advantage |
$57.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.71
|
| Rate for Payer: Cigna Commercial |
$102.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.65
|
| Rate for Payer: Clover Medicare Advantage |
$16.77
|
| Rate for Payer: EmblemHealth Commercial |
$52.95
|
| Rate for Payer: Humana Medicare Advantage |
$18.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.65
|
| 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 |
$14.12
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.43
|
|
|
CH FACTOR VII
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
397071194
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$20.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.85
|
|
|
CH FACTOR VII
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
397071194
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: Aetna Medicare Advantage |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.61
|
| Rate for Payer: Cigna Commercial |
$69.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.90
|
| Rate for Payer: Clover Medicare Advantage |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$53.70
|
| Rate for Payer: Humana Medicare Advantage |
$18.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.68
|
|
|
CH FACTOR VIII
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
397071192
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: Aetna Medicare Advantage |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.61
|
| Rate for Payer: Cigna Commercial |
$132.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.90
|
| Rate for Payer: Clover Medicare Advantage |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$53.70
|
| Rate for Payer: Humana Medicare Advantage |
$18.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$79.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.00
|
|
|
CH FACTOR VIII
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
397071192
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.60
|
|
|
CH FACTOR X
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
397071188
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: Aetna Medicare Advantage |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.61
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.90
|
| Rate for Payer: Clover Medicare Advantage |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$53.70
|
| Rate for Payer: Humana Medicare Advantage |
$18.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.90
|
| 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 |
$14.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH FACTOR X
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
397071188
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH FACTOR XI
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
397071186
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.60
|
|
|
CH FACTOR XI
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
397071186
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: Aetna Medicare Advantage |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.61
|
| Rate for Payer: Cigna Commercial |
$132.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.90
|
| Rate for Payer: Clover Medicare Advantage |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$53.70
|
| Rate for Payer: Humana Medicare Advantage |
$18.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$79.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.00
|
|
|
CH FACTOR XII
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
397071184
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.55 |
| Max. Negotiated Rate |
$50.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.55
|
|
|
CH FACTOR XII
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
397071184
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$168.50 |
| Rate for Payer: Aetna Commercial |
$52.63
|
| Rate for Payer: Aetna Medicare Advantage |
$62.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$69.85
|
| Rate for Payer: Cigna Commercial |
$168.50
|
| Rate for Payer: Cigna Medicare Advantage |
$19.35
|
| Rate for Payer: Clover Medicare Advantage |
$18.38
|
| Rate for Payer: EmblemHealth Commercial |
$58.05
|
| Rate for Payer: Humana Medicare Advantage |
$19.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.93
|
|
|
CH FACTOR XIII
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 85291
|
| Hospital Charge Code |
397071338
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$24.78
|
| Rate for Payer: Aetna Medicare Advantage |
$29.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.88
|
| Rate for Payer: Cigna Commercial |
$102.50
|
| Rate for Payer: Cigna Medicare Advantage |
$9.11
|
| Rate for Payer: Clover Medicare Advantage |
$8.65
|
| Rate for Payer: EmblemHealth Commercial |
$27.33
|
| Rate for Payer: Humana Medicare Advantage |
$9.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.11
|
| 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 |
$7.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.43
|
|
|
CH FACTOR XIII
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 85291
|
| Hospital Charge Code |
397071338
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.75
|
|
|
CH FECAL FAT/MUSCLE QL
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 82705
|
| Hospital Charge Code |
397073069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.45 |
| Max. Negotiated Rate |
$15.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.45
|
|
|
CH FECAL FAT/MUSCLE QL
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 82705
|
| Hospital Charge Code |
397073069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna Medicare Advantage |
$16.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.41
|
| Rate for Payer: Cigna Commercial |
$51.50
|
| Rate for Payer: Cigna Medicare Advantage |
$5.10
|
| Rate for Payer: Clover Medicare Advantage |
$4.84
|
| Rate for Payer: EmblemHealth Commercial |
$15.30
|
| Rate for Payer: Humana Medicare Advantage |
$5.25
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.08
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.73
|
|
|
CH FECAL FAT QUANT
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
HCPCS 82710
|
| Hospital Charge Code |
397072069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$46.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.65
|
|
|
CH FECAL FAT QUANT
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
HCPCS 82710
|
| Hospital Charge Code |
397072069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$155.50 |
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: Aetna Medicare Advantage |
$54.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.80
|
| 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 |
$60.64
|
| Rate for Payer: Cigna Commercial |
$155.50
|
| Rate for Payer: Cigna Medicare Advantage |
$16.80
|
| Rate for Payer: Clover Medicare Advantage |
$15.96
|
| Rate for Payer: EmblemHealth Commercial |
$50.40
|
| Rate for Payer: Humana Medicare Advantage |
$17.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.24
|
|
|
CH FECAL GLOBULIN, MEDICARE
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 82274
|
| Hospital Charge Code |
397071462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$14.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.10
|
|
|
CH FECAL GLOBULIN, MEDICARE
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 82274
|
| Hospital Charge Code |
397071462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$43.30
|
| Rate for Payer: Aetna Medicare Advantage |
$51.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.47
|
| Rate for Payer: Cigna Commercial |
$47.00
|
| Rate for Payer: Cigna Medicare Advantage |
$15.92
|
| Rate for Payer: Clover Medicare Advantage |
$15.12
|
| Rate for Payer: EmblemHealth Commercial |
$47.76
|
| Rate for Payer: Humana Medicare Advantage |
$16.40
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.49
|
|
|
CH FERRITIN
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
397071046
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.40
|
|
|
CH FERRITIN
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
397071046
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$37.07
|
| Rate for Payer: Aetna Medicare Advantage |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.20
|
| Rate for Payer: Cigna Commercial |
$58.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.63
|
| Rate for Payer: Clover Medicare Advantage |
$12.95
|
| Rate for Payer: EmblemHealth Commercial |
$40.89
|
| Rate for Payer: Humana Medicare Advantage |
$14.04
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.07
|
|
|
CH FETAL MAT HEM TEST
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
397031061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.95
|
|
