|
CH HEPATITIS SCREEN
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
397071281
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.90
|
|
|
CH HEPATITIS SCREEN
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
397071281
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$30.63
|
| Rate for Payer: Aetna Medicare Advantage |
$36.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.26
|
| 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 |
$40.65
|
| Rate for Payer: Cigna Commercial |
$123.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.26
|
| Rate for Payer: Clover Medicare Advantage |
$10.70
|
| Rate for Payer: EmblemHealth Commercial |
$33.78
|
| Rate for Payer: Humana Medicare Advantage |
$11.60
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.01
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.52
|
|
|
CH HEPATITUS D ANITIGEN
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
HCPCS 87380
|
| Hospital Charge Code |
397071401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.10
|
|
|
CH HEPATITUS D ANITIGEN
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
HCPCS 87380
|
| Hospital Charge Code |
397071401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna Medicare Advantage |
$59.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.27
|
| Rate for Payer: Cigna Commercial |
$187.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.36
|
| Rate for Payer: Clover Medicare Advantage |
$17.44
|
| Rate for Payer: EmblemHealth Commercial |
$55.08
|
| Rate for Payer: Humana Medicare Advantage |
$18.91
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.91
|
|
|
CH HEPTIMAX (R) HCV RNA
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
397071505
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.81 |
| Max. Negotiated Rate |
$562.50 |
| 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 |
$236.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.64
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| 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 |
$337.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| 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 |
$29.81
|
|
|
CH HEPTIMAX (R) HCV RNA
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
397071505
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
CH HERPES VIRUS 6,IGG,M CSF
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
397073639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$95.25 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.25
|
|
|
CH HERPES VIRUS 6,IGG,M CSF
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
397073639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$459.20 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$459.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$317.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$190.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.83
|
|
|
CH HERPES VIRUS 8 DNA QL PCR
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
397071517
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.20
|
|
|
CH HERPES VIRUS 8 DNA QL PCR
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
397071517
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$153.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$414.00
|
| Rate for Payer: Cigna Medicare Advantage |
$35.09
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.94
|
|
|
CH HGB ELECTROPHORESIS
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
397071002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.25
|
|
|
CH HGB ELECTROPHORESIS
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
397071002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.46
|
| Rate for Payer: Cigna Commercial |
$117.50
|
| 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 |
$70.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.25
|
| 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 |
$6.23
|
|
|
CH HGB & HCT
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
397021089
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
|
|
CH HGB & HCT
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
397021089
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$6.45
|
| Rate for Payer: Aetna Medicare Advantage |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.55
|
| Rate for Payer: Cigna Commercial |
$15.00
|
| Rate for Payer: Cigna Medicare Advantage |
$2.37
|
| Rate for Payer: Clover Medicare Advantage |
$2.25
|
| Rate for Payer: EmblemHealth Commercial |
$7.11
|
| Rate for Payer: Humana Medicare Advantage |
$2.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.80
|
|
|
CH HGB & HCT FLUID
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
397021086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$6.45
|
| Rate for Payer: Aetna Medicare Advantage |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.55
|
| Rate for Payer: Cigna Commercial |
$22.50
|
| Rate for Payer: Cigna Medicare Advantage |
$2.37
|
| Rate for Payer: Clover Medicare Advantage |
$2.25
|
| Rate for Payer: EmblemHealth Commercial |
$7.11
|
| Rate for Payer: Humana Medicare Advantage |
$2.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.19
|
|
|
CH HGB & HCT FLUID
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
397021086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.75
|
|
|
CH H. INFLUENZA TYPE B (IGG)
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
HCPCS 86684
|
| Hospital Charge Code |
397073642
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$80.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.40
|
|
|
CH H. INFLUENZA TYPE B (IGG)
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
HCPCS 86684
|
| Hospital Charge Code |
397073642
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna Commercial |
$43.08
|
| Rate for Payer: Aetna Medicare Advantage |
$51.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.84
|
| 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 |
$57.18
|
| Rate for Payer: Cigna Commercial |
$268.00
|
| Rate for Payer: Cigna Medicare Advantage |
$15.84
|
| Rate for Payer: Clover Medicare Advantage |
$15.05
|
| Rate for Payer: EmblemHealth Commercial |
$47.52
|
| Rate for Payer: Humana Medicare Advantage |
$16.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.20
|
|
|
CH HISTAMINE PLASMA
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
HCPCS 83088
|
| Hospital Charge Code |
397071340
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.40
|
|
|
CH HISTAMINE PLASMA
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
HCPCS 83088
|
| Hospital Charge Code |
397071340
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna Commercial |
$80.32
|
| Rate for Payer: Aetna Medicare Advantage |
$95.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$106.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$106.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$77.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$106.59
|
| Rate for Payer: Cigna Commercial |
$368.00
|
| Rate for Payer: Cigna Medicare Advantage |
$29.53
|
| Rate for Payer: Clover Medicare Advantage |
$28.05
|
| Rate for Payer: EmblemHealth Commercial |
$88.59
|
| Rate for Payer: Humana Medicare Advantage |
$30.42
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$29.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$220.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.50
|
|
|
CH HISTAMINE RELEASE (CU)
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 86343
|
| Hospital Charge Code |
397071442
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$33.89
|
| Rate for Payer: Aetna Medicare Advantage |
$40.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.46
|
| 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 |
$44.98
|
| Rate for Payer: Cigna Commercial |
$48.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.46
|
| Rate for Payer: Clover Medicare Advantage |
$11.84
|
| Rate for Payer: EmblemHealth Commercial |
$37.38
|
| Rate for Payer: Humana Medicare Advantage |
$12.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.97
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.57
|
|
|
CH HISTAMINE RELEASE (CU)
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 86343
|
| Hospital Charge Code |
397071442
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.55
|
|
|
CH HISTAMINE URINE
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
HCPCS 83088
|
| Hospital Charge Code |
397072085
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.40
|
|
|
CH HISTAMINE URINE
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
HCPCS 83088
|
| Hospital Charge Code |
397072085
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna Commercial |
$80.32
|
| Rate for Payer: Aetna Medicare Advantage |
$95.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$106.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$106.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$77.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$106.59
|
| Rate for Payer: Cigna Commercial |
$368.00
|
| Rate for Payer: Cigna Medicare Advantage |
$29.53
|
| Rate for Payer: Clover Medicare Advantage |
$28.05
|
| Rate for Payer: EmblemHealth Commercial |
$88.59
|
| Rate for Payer: Humana Medicare Advantage |
$30.42
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$29.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$220.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.50
|
|
|
CH HISTAMINE WHOLE BLOOD
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
HCPCS 83088
|
| Hospital Charge Code |
397072084
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna Commercial |
$80.32
|
| Rate for Payer: Aetna Medicare Advantage |
$95.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$106.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$106.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$77.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$106.59
|
| Rate for Payer: Cigna Commercial |
$395.00
|
| Rate for Payer: Cigna Medicare Advantage |
$29.53
|
| Rate for Payer: Clover Medicare Advantage |
$28.05
|
| Rate for Payer: EmblemHealth Commercial |
$88.59
|
| Rate for Payer: Humana Medicare Advantage |
$30.42
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$29.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.93
|
|
