|
CH FRESH FRZN PLAS CRYO POOR
|
Facility
|
IP
|
$289.45
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
397031174
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$43.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.42
|
|
|
CH FRUCTOSAMINE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 82985
|
| Hospital Charge Code |
397072072
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.60
|
|
|
CH FRUCTOSAMINE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 82985
|
| Hospital Charge Code |
397072072
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$45.59
|
| Rate for Payer: Aetna Medicare Advantage |
$54.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.76
|
| 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 |
$60.50
|
| Rate for Payer: Cigna Commercial |
$62.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.76
|
| Rate for Payer: Clover Medicare Advantage |
$15.92
|
| Rate for Payer: EmblemHealth Commercial |
$50.28
|
| Rate for Payer: Humana Medicare Advantage |
$17.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.41
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.29
|
|
|
CH FRUCTOSE, SEMEN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 82757
|
| Hospital Charge Code |
397072073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$47.16
|
| Rate for Payer: Aetna Medicare Advantage |
$56.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$43.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.59
|
| Rate for Payer: Cigna Commercial |
$55.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.34
|
| Rate for Payer: Clover Medicare Advantage |
$16.47
|
| Rate for Payer: EmblemHealth Commercial |
$52.02
|
| Rate for Payer: Humana Medicare Advantage |
$17.86
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.92
|
|
|
CH FRUCTOSE, SEMEN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 82757
|
| Hospital Charge Code |
397072073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
|
|
CH G6PD
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 82955
|
| Hospital Charge Code |
397071302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$16.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.95
|
|
|
CH G6PD
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 82955
|
| Hospital Charge Code |
397071302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$26.38
|
| Rate for Payer: Aetna Medicare Advantage |
$31.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.70
|
| 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 |
$35.01
|
| Rate for Payer: Cigna Commercial |
$56.50
|
| Rate for Payer: Cigna Medicare Advantage |
$9.70
|
| Rate for Payer: Clover Medicare Advantage |
$9.21
|
| Rate for Payer: EmblemHealth Commercial |
$29.10
|
| Rate for Payer: Humana Medicare Advantage |
$9.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.99
|
|
|
CH GABITRIL
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.10
|
|
|
CH GABITRIL
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$147.00 |
| 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 |
$147.00
|
| 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 |
$88.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.10
|
| 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 |
$7.79
|
|
|
CH GANGLIOSIDE GD1A AB (IGG)
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$142.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.53
|
|
|
CH GANGLIOSIDE GD1A AB (IGG)
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$42.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.60
|
|
|
CH GANGLIOSIDE GD1A AB (IGM)
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071525
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$149.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$89.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.92
|
|
|
CH GANGLIOSIDE GD1A AB (IGM)
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071525
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.85
|
|
|
CH GANGLIOSIDE GD1B AB IGG
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071497
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$42.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.60
|
|
|
CH GANGLIOSIDE GD1B AB IGG
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071497
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$142.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.53
|
|
|
CH GANGLIOSIDE GD1B AB IGM
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071498
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$190.50 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$190.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.10
|
|
|
CH GANGLIOSIDE GD1B AB IGM
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071498
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.15 |
| Max. Negotiated Rate |
$57.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.15
|
|
|
CH GANGLIOSIDE GQ1B AB (IGG)
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071526
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.16
|
|
|
CH GANGLIOSIDE GQ1B AB (IGG)
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397071526
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.85
|
|
|
CH GASTRIC ANALYSIS
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 82930
|
| Hospital Charge Code |
397071043
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.45
|
|
|
CH GASTRIC ANALYSIS
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 82930
|
| Hospital Charge Code |
397071043
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Aetna Medicare Advantage |
$21.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.22
|
| Rate for Payer: Cigna Commercial |
$91.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6.71
|
| Rate for Payer: Clover Medicare Advantage |
$6.37
|
| Rate for Payer: EmblemHealth Commercial |
$20.13
|
| Rate for Payer: Humana Medicare Advantage |
$6.91
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.71
|
| 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 |
$5.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.85
|
|
|
CH GASTRIN LEVEL
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 82941
|
| Hospital Charge Code |
397071135
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.10
|
|
|
CH GASTRIN LEVEL
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 82941
|
| Hospital Charge Code |
397071135
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$47.95
|
| Rate for Payer: Aetna Medicare Advantage |
$57.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.63
|
| 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 |
$63.64
|
| Rate for Payer: Cigna Commercial |
$57.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.63
|
| Rate for Payer: Clover Medicare Advantage |
$16.75
|
| Rate for Payer: EmblemHealth Commercial |
$52.89
|
| Rate for Payer: Humana Medicare Advantage |
$18.16
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.02
|
|
|
CH GENTAMICIN - PEAK
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
397073144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Aetna Medicare Advantage |
$53.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.13
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.38
|
| Rate for Payer: Clover Medicare Advantage |
$15.56
|
| Rate for Payer: EmblemHealth Commercial |
$49.14
|
| Rate for Payer: Humana Medicare Advantage |
$16.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.38
|
| 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 |
$13.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH GENTAMICIN - PEAK
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
397073144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
