|
CH GLUCOSE, GESTATIONAL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
397073174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CH GLUCOSE, POC
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
397073606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
|
|
CH GLUCOSE, POC
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
397073606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$13.71
|
| Rate for Payer: Aetna Medicare Advantage |
$16.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.19
|
| Rate for Payer: Cigna Commercial |
$28.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.04
|
| Rate for Payer: Clover Medicare Advantage |
$4.79
|
| Rate for Payer: EmblemHealth Commercial |
$15.12
|
| Rate for Payer: Humana Medicare Advantage |
$5.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.48
|
|
|
CH GLUCOSE POST PRANDIAL 2HR
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
397071066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$12.92
|
| Rate for Payer: Aetna Medicare Advantage |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.75
|
| Rate for Payer: Clover Medicare Advantage |
$4.51
|
| Rate for Payer: EmblemHealth Commercial |
$14.25
|
| Rate for Payer: Humana Medicare Advantage |
$4.89
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.75
|
| 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 |
$3.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH GLUCOSE POST PRANDIAL 2HR
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
397071066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH GLUCOSE RANDOM URINE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 81005
|
| Hospital Charge Code |
397071022
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH GLUCOSE RANDOM URINE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 81005
|
| Hospital Charge Code |
397071022
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$5.90
|
| Rate for Payer: Aetna Medicare Advantage |
$7.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.83
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$2.17
|
| Rate for Payer: Clover Medicare Advantage |
$2.06
|
| Rate for Payer: EmblemHealth Commercial |
$6.51
|
| Rate for Payer: Humana Medicare Advantage |
$2.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.17
|
| 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 |
$1.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH GLUCOSE SPINAL FLUID
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
397071129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
|
|
CH GLUCOSE SPINAL FLUID
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
397071129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$10.69
|
| Rate for Payer: Aetna Medicare Advantage |
$12.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.19
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: Cigna Medicare Advantage |
$3.93
|
| Rate for Payer: Clover Medicare Advantage |
$3.73
|
| Rate for Payer: EmblemHealth Commercial |
$11.79
|
| Rate for Payer: Humana Medicare Advantage |
$4.05
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.25
|
|
|
CH GLUCOSE TOLERANCE 3HR
|
Facility
|
OP
|
$304.85
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
397071111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$152.43 |
| Rate for Payer: Aetna Commercial |
$35.01
|
| Rate for Payer: Aetna Medicare Advantage |
$41.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.87
|
| 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 |
$46.46
|
| Rate for Payer: Cigna Commercial |
$152.43
|
| Rate for Payer: Cigna Medicare Advantage |
$12.87
|
| Rate for Payer: Clover Medicare Advantage |
$12.23
|
| Rate for Payer: EmblemHealth Commercial |
$38.61
|
| Rate for Payer: Humana Medicare Advantage |
$13.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$91.45
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.08
|
|
|
CH GLUCOSE TOLERANCE 3HR
|
Facility
|
IP
|
$304.85
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
397071111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.73 |
| Max. Negotiated Rate |
$45.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.73
|
|
|
CH GLUCOSE URINE 24HR
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
397073164
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH GLUCOSE URINE 24HR
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
397073164
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$10.69
|
| Rate for Payer: Aetna Medicare Advantage |
$12.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.19
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.93
|
| Rate for Payer: Clover Medicare Advantage |
$3.73
|
| Rate for Payer: EmblemHealth Commercial |
$11.79
|
| Rate for Payer: Humana Medicare Advantage |
$4.05
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.93
|
| 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 |
$3.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH GLYBURIDE
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397071547
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.85
|
|
|
CH GLYBURIDE
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397071547
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$149.50 |
| 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 |
$149.50
|
| 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 |
$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 |
$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 |
$7.92
|
|
|
CH GLYCOHEMOGLOBIN
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
397071178
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$167.50 |
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: Aetna Medicare Advantage |
$31.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.71
|
| 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 |
$35.05
|
| Rate for Payer: Cigna Commercial |
$167.50
|
| Rate for Payer: Cigna Medicare Advantage |
$9.71
|
| Rate for Payer: Clover Medicare Advantage |
$9.22
|
| Rate for Payer: EmblemHealth Commercial |
$29.13
|
| Rate for Payer: Humana Medicare Advantage |
$10.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.71
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.88
|
|
|
CH GLYCOHEMOGLOBIN
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
397071178
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.25 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
|
|
CH GLYCOMARK
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 84378
|
| Hospital Charge Code |
397073674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$31.36
|
| Rate for Payer: Aetna Medicare Advantage |
$37.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.62
|
| Rate for Payer: Cigna Commercial |
$85.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.53
|
| Rate for Payer: Clover Medicare Advantage |
$10.95
|
| Rate for Payer: EmblemHealth Commercial |
$34.59
|
| Rate for Payer: Humana Medicare Advantage |
$11.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$51.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.53
|
|
|
CH GLYCOMARK
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 84378
|
| Hospital Charge Code |
397073674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.65
|
|
|
CH GOLD
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 80375
|
| Hospital Charge Code |
397071339
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.94
|
|
|
CH GOLD
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 80375
|
| Hospital Charge Code |
397071339
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
CH GRAM STAIN
|
Facility
|
OP
|
$546.91
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
397041064
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$273.45 |
| Rate for Payer: Aetna Commercial |
$11.61
|
| Rate for Payer: Aetna Medicare Advantage |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.41
|
| Rate for Payer: Cigna Commercial |
$273.45
|
| Rate for Payer: Cigna Medicare Advantage |
$4.27
|
| Rate for Payer: Clover Medicare Advantage |
$4.06
|
| Rate for Payer: EmblemHealth Commercial |
$12.81
|
| Rate for Payer: Humana Medicare Advantage |
$4.40
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.07
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.49
|
|
|
CH GRAM STAIN
|
Facility
|
IP
|
$546.91
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
397041064
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$82.04 |
| Max. Negotiated Rate |
$82.04 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.04
|
|
|
CH GRANULOCYTE APHERESIS
|
Facility
|
IP
|
$12,480.00
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
397031040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,872.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,872.00
|
|
|
CH GRANULOCYTE APHERESIS
|
Facility
|
OP
|
$12,480.00
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
397031040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$300.77 |
| Max. Negotiated Rate |
$6,240.00 |
| Rate for Payer: Aetna Commercial |
$4,742.40
|
| Rate for Payer: Aetna Medicare Advantage |
$3,744.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,182.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,182.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,182.40
|
| Rate for Payer: Cigna Commercial |
$6,240.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,744.00
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,872.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$300.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$330.72
|
|
