|
CH GROWTH HORMONE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
397071247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$45.34
|
| Rate for Payer: Aetna Medicare Advantage |
$54.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.67
|
| 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 |
$60.17
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.67
|
| Rate for Payer: Clover Medicare Advantage |
$15.84
|
| Rate for Payer: EmblemHealth Commercial |
$50.01
|
| Rate for Payer: Humana Medicare Advantage |
$17.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.67
|
| 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 |
$13.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH GROWTH HORMONE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
397071247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH HALDOL
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 80173
|
| Hospital Charge Code |
397073339
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$42.92
|
| Rate for Payer: Aetna Medicare Advantage |
$51.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.96
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: Cigna Medicare Advantage |
$15.78
|
| Rate for Payer: Clover Medicare Advantage |
$14.99
|
| Rate for Payer: EmblemHealth Commercial |
$47.34
|
| Rate for Payer: Humana Medicare Advantage |
$16.25
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.78
|
| 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 |
$12.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.94
|
|
|
CH HALDOL
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 80173
|
| Hospital Charge Code |
397073339
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
CH HAM TEST(HEMOLYSINS INCUB
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
397021004
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.70
|
|
|
CH HAM TEST(HEMOLYSINS INCUB
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
397021004
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.94
|
| Rate for Payer: Aetna Medicare Advantage |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$26.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.71
|
| Rate for Payer: Cigna Commercial |
$39.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.11
|
| Rate for Payer: Clover Medicare Advantage |
$11.50
|
| Rate for Payer: EmblemHealth Commercial |
$36.33
|
| Rate for Payer: Humana Medicare Advantage |
$12.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.11
|
| 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 |
$9.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.07
|
|
|
CH HAPTOGLOBIN
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
397071221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$11.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.85
|
|
|
CH HAPTOGLOBIN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
397071221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$34.22
|
| Rate for Payer: Aetna Medicare Advantage |
$40.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.41
|
| Rate for Payer: Cigna Commercial |
$39.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.58
|
| Rate for Payer: Clover Medicare Advantage |
$11.95
|
| Rate for Payer: EmblemHealth Commercial |
$37.74
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.09
|
|
|
CH HB CORE AB W(IGM) RFX
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
397071428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare Advantage |
$39.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.50
|
| Rate for Payer: Cigna Commercial |
$21.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.45
|
| Rate for Payer: EmblemHealth Commercial |
$36.15
|
| Rate for Payer: Humana Medicare Advantage |
$12.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.11
|
|
|
CH HB CORE AB W(IGM) RFX
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
397071428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.30
|
|
|
CH HBG S NEG BLD
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
397031047
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.00
|
|
|
CH HBG S NEG BLD
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
397031047
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$476.24
|
| Rate for Payer: Aetna Medicare Advantage |
$567.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$632.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$632.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$175.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$632.02
|
| Rate for Payer: Cigna Commercial |
$350.96
|
| Rate for Payer: Cigna Medicare Advantage |
$175.09
|
| Rate for Payer: Clover Medicare Advantage |
$166.34
|
| Rate for Payer: EmblemHealth Commercial |
$525.27
|
| Rate for Payer: Humana Medicare Advantage |
$180.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$175.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.00
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$175.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.73
|
|
|
CH H. BRAZILIENSIS (K82) IGE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397071432
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$55.00
|
| 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 |
$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 |
$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 |
$2.92
|
|
|
CH H. BRAZILIENSIS (K82) IGE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397071506
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$15.50
|
| 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 |
$9.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.65
|
| 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 |
$0.82
|
|
|
CH H. BRAZILIENSIS (K82) IGE
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397071506
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.65
|
|
|
CH H. BRAZILIENSIS (K82) IGE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397071432
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
|
|
CH HBSAG W/REFLEX CONF
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
397071453
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$28.10
|
| Rate for Payer: Aetna Medicare Advantage |
$33.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.29
|
| Rate for Payer: Cigna Commercial |
$31.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.33
|
| Rate for Payer: Clover Medicare Advantage |
$9.81
|
| Rate for Payer: EmblemHealth Commercial |
$30.99
|
| Rate for Payer: Humana Medicare Advantage |
$10.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.64
|
|
|
CH HBSAG W/REFLEX CONF
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
397071453
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.30
|
|
|
CH HBV,DNA,QN,PCR
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
397073599
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.75
|
|
|
CH HBV,DNA,QN,PCR
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
397073599
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$154.64 |
| Rate for Payer: Aetna Commercial |
$116.52
|
| Rate for Payer: Aetna Medicare Advantage |
$138.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$154.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.64
|
| Rate for Payer: Cigna Commercial |
$132.50
|
| Rate for Payer: Cigna Medicare Advantage |
$42.84
|
| Rate for Payer: Clover Medicare Advantage |
$40.70
|
| Rate for Payer: EmblemHealth Commercial |
$128.52
|
| Rate for Payer: Humana Medicare Advantage |
$44.13
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$42.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$79.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$42.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.02
|
|
|
CH HCG
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
397073240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Aetna Commercial |
$40.94
|
| Rate for Payer: Aetna Medicare Advantage |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.33
|
| Rate for Payer: Cigna Commercial |
$316.50
|
| Rate for Payer: Cigna Medicare Advantage |
$15.05
|
| Rate for Payer: Clover Medicare Advantage |
$14.30
|
| Rate for Payer: EmblemHealth Commercial |
$45.15
|
| Rate for Payer: Humana Medicare Advantage |
$15.50
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$189.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.77
|
|
|
CH HCG
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
397073240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.95 |
| Max. Negotiated Rate |
$94.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.95
|
|
|
CH HCG QUAL
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
397071074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$20.45
|
| Rate for Payer: Aetna Medicare Advantage |
$24.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.52
|
| 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 |
$27.14
|
| Rate for Payer: Cigna Commercial |
$105.00
|
| Rate for Payer: Cigna Medicare Advantage |
$7.52
|
| Rate for Payer: Clover Medicare Advantage |
$7.14
|
| Rate for Payer: EmblemHealth Commercial |
$22.56
|
| Rate for Payer: Humana Medicare Advantage |
$7.75
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.57
|
|
|
CH HCG QUAL
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
397071074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
|
|
CH HCG, QUAN
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
397073036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Aetna Commercial |
$40.94
|
| Rate for Payer: Aetna Medicare Advantage |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.33
|
| Rate for Payer: Cigna Commercial |
$316.50
|
| Rate for Payer: Cigna Medicare Advantage |
$15.05
|
| Rate for Payer: Clover Medicare Advantage |
$14.30
|
| Rate for Payer: EmblemHealth Commercial |
$45.15
|
| Rate for Payer: Humana Medicare Advantage |
$15.50
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$189.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.77
|
|
