|
CH FLUORETINE
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.58 |
| 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 |
$86.50
|
| 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 |
$51.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| 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 |
$4.58
|
|
|
CH FLUORETINE
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
CH FLUOXETINE (PROZAC)
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073350
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$172.00 |
| 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 |
$172.00
|
| 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 |
$103.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.60
|
| 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 |
$9.12
|
|
|
CH FLUOXETINE (PROZAC)
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073350
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.60
|
|
|
CH FLUPHENAZINE
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073070
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| 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 |
$97.50
|
| 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 |
$58.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.25
|
| 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 |
$5.17
|
|
|
CH FLUPHENAZINE
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073070
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.25
|
|
|
CH FLURAZEPAM
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
397073071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.96
|
|
|
CH FLURAZEPAM
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
397073071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CH FOLATE, RBC
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 82747
|
| Hospital Charge Code |
397070019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.07 |
| 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 |
$34.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.71
|
| Rate for Payer: Cigna Commercial |
$39.00
|
| 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 |
$23.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.70
|
| 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 |
$2.07
|
|
|
CH FOLATE, RBC
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 82747
|
| Hospital Charge Code |
397070019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.70
|
|
|
CH FOLIC ACID
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
397071268
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$39.98
|
| Rate for Payer: Aetna Medicare Advantage |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.06
|
| Rate for Payer: Cigna Commercial |
$45.50
|
| Rate for Payer: Cigna Medicare Advantage |
$14.70
|
| Rate for Payer: Clover Medicare Advantage |
$13.96
|
| Rate for Payer: EmblemHealth Commercial |
$44.10
|
| Rate for Payer: Humana Medicare Advantage |
$15.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.41
|
|
|
CH FOLIC ACID
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
397071268
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.65
|
|
|
CH FOLLICLE STIMULAT HORMONE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83001
|
| Hospital Charge Code |
397071180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Medicare Advantage |
$60.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.07
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.58
|
| Rate for Payer: Clover Medicare Advantage |
$17.65
|
| Rate for Payer: EmblemHealth Commercial |
$55.74
|
| Rate for Payer: Humana Medicare Advantage |
$19.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.58
|
| 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 |
$14.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH FOLLICLE STIMULAT HORMONE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83001
|
| Hospital Charge Code |
397071180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH FOOD ALLERGY
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397073621
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.30
|
|
|
CH FOOD ALLERGY
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397073621
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$171.00 |
| 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 |
$171.00
|
| 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 |
$102.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.30
|
| 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 |
$9.06
|
|
|
CH FRAGILE X DNA PROBE
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
HCPCS 81200
|
| Hospital Charge Code |
397071009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$79.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.05
|
|
|
CH FRAGILE X DNA PROBE
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
HCPCS 81200
|
| Hospital Charge Code |
397071009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare Advantage |
$153.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$170.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$170.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$170.56
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: Cigna Medicare Advantage |
$47.25
|
| Rate for Payer: Clover Medicare Advantage |
$44.89
|
| Rate for Payer: EmblemHealth Commercial |
$141.75
|
| Rate for Payer: Humana Medicare Advantage |
$48.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$47.25
|
| 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 |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$37.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$47.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.97
|
|
|
CH FREE KAPPA LAMBDA RAND UR
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
397071509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$36.99
|
| Rate for Payer: Aetna Medicare Advantage |
$44.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.09
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.60
|
| Rate for Payer: Clover Medicare Advantage |
$12.92
|
| Rate for Payer: EmblemHealth Commercial |
$40.80
|
| Rate for Payer: Humana Medicare Advantage |
$14.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$204.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.02
|
|
|
CH FREE KAPPA LAMBDA RAND UR
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
397071509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
|
|
CH FREE KAPPA LAMBDA (SERUM)
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
397071510
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
|
|
CH FREE KAPPA LAMBDA (SERUM)
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
397071510
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$36.99
|
| Rate for Payer: Aetna Medicare Advantage |
$44.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.09
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.60
|
| Rate for Payer: Clover Medicare Advantage |
$12.92
|
| Rate for Payer: EmblemHealth Commercial |
$40.80
|
| Rate for Payer: Humana Medicare Advantage |
$14.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$204.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.02
|
|
|
CH FREE T3
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
397073592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$46.08
|
| Rate for Payer: Aetna Medicare Advantage |
$54.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.15
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$16.94
|
| Rate for Payer: Clover Medicare Advantage |
$16.09
|
| Rate for Payer: EmblemHealth Commercial |
$50.82
|
| Rate for Payer: Humana Medicare Advantage |
$17.45
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.28
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
CH FREE T3
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
397073592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH FRESH FRZN PLAS CRYO POOR
|
Facility
|
OP
|
$289.45
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
397031174
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: Aetna Medicare Advantage |
$277.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$309.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$309.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$309.64
|
| Rate for Payer: Cigna Commercial |
$171.96
|
| Rate for Payer: Cigna Medicare Advantage |
$85.78
|
| Rate for Payer: Clover Medicare Advantage |
$81.49
|
| Rate for Payer: EmblemHealth Commercial |
$257.34
|
| Rate for Payer: Humana Medicare Advantage |
$88.35
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$86.83
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.67
|
|
