|
CH KAPPA LAMBDA W CALC 24H U
|
Facility
|
OP
|
$905.00
|
|
| Hospital Charge Code |
3970731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.81 |
| Max. Negotiated Rate |
$452.50 |
| Rate for Payer: Aetna Commercial |
$343.90
|
| Rate for Payer: Aetna Medicare Advantage |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$230.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$230.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$230.78
|
| Rate for Payer: Cigna Commercial |
$452.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.98
|
|
|
CH KETOGENIC 17 STEROID
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS 83582
|
| Hospital Charge Code |
397073013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.30
|
|
|
CH KETOGENIC 17 STEROID
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS 83582
|
| Hospital Charge Code |
397073013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$42.08
|
| Rate for Payer: Aetna Medicare Advantage |
$50.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.47
|
| 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 |
$55.84
|
| Rate for Payer: Cigna Commercial |
$111.00
|
| Rate for Payer: Cigna Medicare Advantage |
$15.47
|
| Rate for Payer: Clover Medicare Advantage |
$14.70
|
| Rate for Payer: EmblemHealth Commercial |
$46.41
|
| Rate for Payer: Humana Medicare Advantage |
$15.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$66.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.88
|
|
|
CH KETONES SERUM
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82009
|
| Hospital Charge Code |
397071272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH KETONES SERUM
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82009
|
| Hospital Charge Code |
397071272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$12.29
|
| Rate for Payer: Aetna Medicare Advantage |
$14.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.52
|
| 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 |
$16.32
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$4.52
|
| Rate for Payer: Clover Medicare Advantage |
$4.29
|
| Rate for Payer: EmblemHealth Commercial |
$13.56
|
| Rate for Payer: Humana Medicare Advantage |
$4.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.28
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
CH KETOSTEROID - 17 FRACTION
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS 83593
|
| Hospital Charge Code |
397072144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna Commercial |
$77.52
|
| Rate for Payer: Aetna Medicare Advantage |
$92.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$28.50
|
| 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 |
$102.88
|
| Rate for Payer: Cigna Commercial |
$367.50
|
| Rate for Payer: Cigna Medicare Advantage |
$28.50
|
| Rate for Payer: Clover Medicare Advantage |
$27.07
|
| Rate for Payer: EmblemHealth Commercial |
$85.50
|
| Rate for Payer: Humana Medicare Advantage |
$29.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$28.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$220.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$28.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.48
|
|
|
CH KETOSTEROID - 17 FRACTION
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS 83593
|
| Hospital Charge Code |
397072144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|
|
CH KETOSTEROID - 17 TOTAL
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 83586
|
| Hospital Charge Code |
397072145
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$34.82
|
| Rate for Payer: Aetna Medicare Advantage |
$41.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.20
|
| Rate for Payer: Cigna Commercial |
$103.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.80
|
| Rate for Payer: Clover Medicare Advantage |
$12.16
|
| Rate for Payer: EmblemHealth Commercial |
$38.40
|
| Rate for Payer: Humana Medicare Advantage |
$13.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.49
|
|
|
CH KETOSTEROID - 17 TOTAL
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 83586
|
| Hospital Charge Code |
397072145
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
|
|
CH KLEINHAUER BETKE TEST
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
397031156
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$21.03
|
| Rate for Payer: Aetna Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.90
|
| Rate for Payer: Cigna Commercial |
$29.50
|
| Rate for Payer: Cigna Medicare Advantage |
$7.73
|
| Rate for Payer: Clover Medicare Advantage |
$7.34
|
| Rate for Payer: EmblemHealth Commercial |
$23.19
|
| Rate for Payer: Humana Medicare Advantage |
$7.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.56
|
|
|
CH KLEINHAUER BETKE TEST
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
397031156
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.85
|
|
|
CH LACTIC ACID
|
Facility
|
OP
|
$113.65
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
397071061
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$31.47
|
| Rate for Payer: Aetna Medicare Advantage |
$37.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.57
|
| 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 |
$41.76
|
| Rate for Payer: Cigna Commercial |
$56.83
|
| Rate for Payer: Cigna Medicare Advantage |
$11.57
|
| Rate for Payer: Clover Medicare Advantage |
$10.99
|
| Rate for Payer: EmblemHealth Commercial |
$34.71
|
| Rate for Payer: Humana Medicare Advantage |
$11.92
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.09
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.01
|
|
|
CH LACTIC ACID
|
Facility
|
IP
|
$113.65
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
397071061
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$17.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.05
|
|
|
CHLAM GCAM I
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
3036030A
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$126.66 |
| 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 |
$38.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$126.00
|
| 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 |
$75.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.80
|
| 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 |
$6.68
|
|
|
CHLAM GCAM I
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
3036030A
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.80
|
|
|
CHLAM GCAM II
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
3036030B
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.80
|
|
|
CHLAM GCAM II
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
3036030B
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$126.66 |
| 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 |
$72.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$126.00
|
| 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 |
$75.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.80
|
| 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 |
$6.68
|
|
|
CHLAM GCAM III
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
3036030C
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$153.02 |
| 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 |
$130.00
|
| 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 |
$78.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
| 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 |
$6.89
|
|
|
CHLAM GCAM III
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
3036030C
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
|
|
CH LAMICTAL
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073349
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.95 |
| Max. Negotiated Rate |
$61.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.95
|
|
|
CH LAMICTAL
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073349
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$206.50 |
| 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 |
$206.50
|
| 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 |
$123.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.95
|
| 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 |
$10.94
|
|
|
CH LAMOTRIGINE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073590
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$72.50
|
| 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 |
$43.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.75
|
| 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 |
$3.84
|
|
|
CH LAMOTRIGINE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073590
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.75
|
|
|
CHLAMYDIA ABCHLAMYDIA AB
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
401386631A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$32.15
|
| Rate for Payer: Aetna Medicare Advantage |
$38.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.67
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.82
|
| Rate for Payer: Clover Medicare Advantage |
$11.23
|
| Rate for Payer: EmblemHealth Commercial |
$35.46
|
| Rate for Payer: Humana Medicare Advantage |
$12.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.82
|
| 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 |
$9.46
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CHLAMYDIA ABCHLAMYDIA AB
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
401386631A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
