|
CH HTLV-I/II ABS CSF (LIA)
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
397073636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$121.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$121.80
|
|
|
CH HYDROPROLINE FREE
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 83500
|
| Hospital Charge Code |
397073583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.50
|
|
|
CH HYDROPROLINE FREE
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 83500
|
| Hospital Charge Code |
397073583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: Aetna Commercial |
$61.61
|
| Rate for Payer: Aetna Medicare Advantage |
$73.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$81.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$81.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$81.76
|
| Rate for Payer: Cigna Commercial |
$205.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.65
|
| Rate for Payer: Clover Medicare Advantage |
$21.52
|
| Rate for Payer: EmblemHealth Commercial |
$67.95
|
| Rate for Payer: Humana Medicare Advantage |
$23.33
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$123.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.12
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.87
|
|
|
CH HYDROPROLINE TOTAL
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
HCPCS 83505
|
| Hospital Charge Code |
397073584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$98.10
|
|
|
CH HYDROPROLINE TOTAL
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
HCPCS 83505
|
| Hospital Charge Code |
397073584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: Aetna Medicare Advantage |
$78.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.72
|
| Rate for Payer: Cigna Commercial |
$327.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.30
|
| Rate for Payer: Clover Medicare Advantage |
$23.09
|
| Rate for Payer: EmblemHealth Commercial |
$72.90
|
| Rate for Payer: Humana Medicare Advantage |
$25.03
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$196.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$98.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.33
|
|
|
CH HYDROXY 5 INDOLE ACE
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS 83497
|
| Hospital Charge Code |
397071077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$51.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.75
|
|
|
CH HYDROXY 5 INDOLE ACE
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS 83497
|
| Hospital Charge Code |
397071077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Aetna Commercial |
$35.09
|
| Rate for Payer: Aetna Medicare Advantage |
$41.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.90
|
| 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 |
$46.57
|
| Rate for Payer: Cigna Commercial |
$172.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.90
|
| Rate for Payer: Clover Medicare Advantage |
$12.26
|
| Rate for Payer: EmblemHealth Commercial |
$38.70
|
| Rate for Payer: Humana Medicare Advantage |
$13.29
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$103.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.14
|
|
|
CH HYDROXYCORTICOST - 17
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS 83491
|
| Hospital Charge Code |
397072146
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$40.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.20
|
|
|
CH HYDROXYCORTICOST - 17
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS 83491
|
| Hospital Charge Code |
397072146
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$134.00 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: Aetna Medicare Advantage |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.90
|
| 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 |
$64.61
|
| Rate for Payer: Cigna Commercial |
$134.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.90
|
| Rate for Payer: Clover Medicare Advantage |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$53.70
|
| Rate for Payer: Humana Medicare Advantage |
$18.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.10
|
|
|
CH HYDROXYPROGESTERONE - 17
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
HCPCS 83498
|
| Hospital Charge Code |
397072143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.60
|
|
|
CH HYDROXYPROGESTERONE - 17
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
HCPCS 83498
|
| Hospital Charge Code |
397072143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$73.90
|
| Rate for Payer: Aetna Medicare Advantage |
$88.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$98.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$98.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$27.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$59.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$98.08
|
| Rate for Payer: Cigna Commercial |
$162.00
|
| Rate for Payer: Cigna Medicare Advantage |
$27.17
|
| Rate for Payer: Clover Medicare Advantage |
$25.81
|
| Rate for Payer: EmblemHealth Commercial |
$81.51
|
| Rate for Payer: Humana Medicare Advantage |
$27.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$27.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$27.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.59
|
|
|
CH HYDROXYPROLINE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 83505
|
| Hospital Charge Code |
397073252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: Aetna Medicare Advantage |
$78.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.72
|
| Rate for Payer: Cigna Commercial |
$75.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.30
|
| Rate for Payer: Clover Medicare Advantage |
$23.09
|
| Rate for Payer: EmblemHealth Commercial |
$72.90
|
| Rate for Payer: Humana Medicare Advantage |
$25.03
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.98
|
|
|
CH HYDROXYPROLINE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 83505
|
| Hospital Charge Code |
397073252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.50
|
|
|
CH HYDROXYPROLINE FREE
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
HCPCS 83500
|
| Hospital Charge Code |
397072090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$61.61
|
| Rate for Payer: Aetna Medicare Advantage |
$73.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$81.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$81.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$81.76
|
| Rate for Payer: Cigna Commercial |
$240.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.65
|
| Rate for Payer: Clover Medicare Advantage |
$21.52
|
| Rate for Payer: EmblemHealth Commercial |
$67.95
|
| Rate for Payer: Humana Medicare Advantage |
$23.33
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$144.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.12
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.72
|
|
|
CH HYDROXYPROLINE FREE
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
HCPCS 83500
|
| Hospital Charge Code |
397072090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.00
|
|
|
CH HYDROXYPROLINE FREE+TOTAL
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
HCPCS 83500
|
| Hospital Charge Code |
397072089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.12 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Aetna Commercial |
$61.61
|
| Rate for Payer: Aetna Medicare Advantage |
$73.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$81.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$81.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$81.76
|
| Rate for Payer: Cigna Commercial |
$501.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.65
|
| Rate for Payer: Clover Medicare Advantage |
$21.52
|
| Rate for Payer: EmblemHealth Commercial |
$67.95
|
| Rate for Payer: Humana Medicare Advantage |
$23.33
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.12
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.55
|
|
|
CH HYDROXYPROLINE FREE+TOTAL
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
HCPCS 83500
|
| Hospital Charge Code |
397072089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$150.30 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.30
|
|
|
CH HYDROXYPROLINE, TOTAL
|
Facility
|
IP
|
$767.00
|
|
|
Service Code
|
HCPCS 83505
|
| Hospital Charge Code |
397073080
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.05 |
| Max. Negotiated Rate |
$115.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.05
|
|
|
CH HYDROXYPROLINE, TOTAL
|
Facility
|
OP
|
$767.00
|
|
|
Service Code
|
HCPCS 83505
|
| Hospital Charge Code |
397073080
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$383.50 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: Aetna Medicare Advantage |
$78.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.72
|
| Rate for Payer: Cigna Commercial |
$383.50
|
| Rate for Payer: Cigna Medicare Advantage |
$24.30
|
| Rate for Payer: Clover Medicare Advantage |
$23.09
|
| Rate for Payer: EmblemHealth Commercial |
$72.90
|
| Rate for Payer: Humana Medicare Advantage |
$25.03
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.33
|
|
|
CH HYPOGLYCEMIC PANEL
|
Facility
|
IP
|
$146.60
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
397071461
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$21.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.99
|
|
|
CH HYPOGLYCEMIC PANEL
|
Facility
|
OP
|
$146.60
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
397071461
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$65.58
|
| Rate for Payer: Aetna Medicare Advantage |
$78.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.03
|
| Rate for Payer: Cigna Commercial |
$73.30
|
| Rate for Payer: Cigna Medicare Advantage |
$24.11
|
| Rate for Payer: Clover Medicare Advantage |
$22.90
|
| Rate for Payer: EmblemHealth Commercial |
$72.33
|
| Rate for Payer: Humana Medicare Advantage |
$24.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.98
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.88
|
|
|
CHIBA 22GA 10CM NEEDLE
|
Facility
|
IP
|
$59.50
|
|
| Hospital Charge Code |
270661636
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.93
|
|
|
CHIBA 22GA 10CM NEEDLE
|
Facility
|
OP
|
$59.50
|
|
| Hospital Charge Code |
270661636
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Aetna Commercial |
$22.61
|
| Rate for Payer: Aetna Medicare Advantage |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.17
|
| Rate for Payer: Cigna Commercial |
$29.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.85
|
| Rate for Payer: Oxford Commercial |
$11.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.58
|
|
|
CH IBD: AB ID, LEUKOCYTE AB
|
Facility
|
IP
|
$3,528.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
397031301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$529.20 |
| Max. Negotiated Rate |
$529.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$529.20
|
|
|
CH IBD: AB ID, LEUKOCYTE AB
|
Facility
|
OP
|
$3,528.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
397031301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$1,764.00 |
| 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 |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.33
|
| Rate for Payer: Cigna Commercial |
$1,764.00
|
| 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 |
$1,058.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$529.20
|
| 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 |
$93.49
|
|
