|
CH LIPID PANEL
|
Facility
|
OP
|
$894.84
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
397073040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$447.42 |
| Rate for Payer: Aetna Commercial |
$36.42
|
| Rate for Payer: Aetna Medicare Advantage |
$43.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.39
|
| 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 |
$48.33
|
| Rate for Payer: Cigna Commercial |
$447.42
|
| Rate for Payer: Cigna Medicare Advantage |
$13.39
|
| Rate for Payer: Clover Medicare Advantage |
$12.72
|
| Rate for Payer: EmblemHealth Commercial |
$40.17
|
| Rate for Payer: Humana Medicare Advantage |
$13.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$268.45
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$134.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.71
|
|
|
CH LIPOPRO HIGHRES FRACT
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
HCPCS 83701
|
| Hospital Charge Code |
397073618
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.15
|
|
|
CH LIPOPRO HIGHRES FRACT
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
HCPCS 83701
|
| Hospital Charge Code |
397073618
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$92.10
|
| Rate for Payer: Aetna Medicare Advantage |
$109.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$122.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$122.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$33.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$122.22
|
| Rate for Payer: Cigna Commercial |
$220.50
|
| Rate for Payer: Cigna Medicare Advantage |
$33.86
|
| Rate for Payer: Clover Medicare Advantage |
$32.17
|
| Rate for Payer: EmblemHealth Commercial |
$101.58
|
| Rate for Payer: Humana Medicare Advantage |
$34.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$33.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$132.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$33.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.69
|
|
|
CH LIPOPROTEIN (A)
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397070009
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$66.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.50
|
|
|
CH LIPOPROTEIN (A)
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397070009
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.80
|
|
|
CH LIPOPROTEIN PHEOTYPI
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 83700
|
| Hospital Charge Code |
397071328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.83 |
| 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 |
$14.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.65
|
| Rate for Payer: Cigna Commercial |
$34.50
|
| 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 |
$20.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.35
|
| 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 |
$1.83
|
|
|
CH LIPOPROTEIN PHEOTYPI
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 83700
|
| Hospital Charge Code |
397071328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$10.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.35
|
|
|
CH LIPOP VERY LOW DENSITY
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 83719
|
| Hospital Charge Code |
397072135
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare Advantage |
$41.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.02
|
| Rate for Payer: Cigna Commercial |
$69.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.75
|
| Rate for Payer: Clover Medicare Advantage |
$12.11
|
| Rate for Payer: EmblemHealth Commercial |
$38.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.13
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.68
|
|
|
CH LIPOP VERY LOW DENSITY
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 83719
|
| Hospital Charge Code |
397072135
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$20.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.85
|
|
|
CH LITHIUM
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 80178
|
| Hospital Charge Code |
397071282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.35
|
|
|
CH LITHIUM
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 80178
|
| Hospital Charge Code |
397071282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$17.98
|
| Rate for Payer: Aetna Medicare Advantage |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.61
|
| 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 |
$23.86
|
| Rate for Payer: Cigna Commercial |
$54.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6.61
|
| Rate for Payer: Clover Medicare Advantage |
$6.28
|
| Rate for Payer: EmblemHealth Commercial |
$19.83
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.89
|
|
|
CHLMYD TRACH DNA AMP PROBE
|
Facility
|
IP
|
$82.95
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
401910123A
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$12.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.44
|
|
|
CHLMYD TRACH DNA AMP PROBE
|
Facility
|
OP
|
$82.95
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
401910123A
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| 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 |
$41.48
|
| 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 |
$24.89
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.44
|
| 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 |
$2.20
|
|
|
CH LONG ACT THYROID SIM
|
Facility
|
IP
|
$1,226.00
|
|
|
Service Code
|
HCPCS 84445
|
| Hospital Charge Code |
397071345
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$183.90 |
| Max. Negotiated Rate |
$183.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.90
|
|
|
CH LONG ACT THYROID SIM
|
Facility
|
OP
|
$1,226.00
|
|
|
Service Code
|
HCPCS 84445
|
| Hospital Charge Code |
397071345
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$613.00 |
| Rate for Payer: Aetna Commercial |
$138.34
|
| Rate for Payer: Aetna Medicare Advantage |
$164.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$183.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$183.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$50.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$183.59
|
| Rate for Payer: Cigna Commercial |
$613.00
|
| Rate for Payer: Cigna Medicare Advantage |
$50.86
|
| Rate for Payer: Clover Medicare Advantage |
$48.32
|
| Rate for Payer: EmblemHealth Commercial |
$152.58
|
| Rate for Payer: Humana Medicare Advantage |
$52.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$50.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$367.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$40.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$50.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.49
|
|
|
CH LONG CHAIN FATTY ACID
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
HCPCS 82726
|
| Hospital Charge Code |
397073353
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$527.50 |
| Rate for Payer: Aetna Commercial |
$53.72
|
| Rate for Payer: Aetna Medicare Advantage |
$63.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.75
|
| 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 |
$71.29
|
| Rate for Payer: Cigna Commercial |
$527.50
|
| Rate for Payer: Cigna Medicare Advantage |
$19.75
|
| Rate for Payer: Clover Medicare Advantage |
$18.76
|
| Rate for Payer: EmblemHealth Commercial |
$59.25
|
| Rate for Payer: Humana Medicare Advantage |
$20.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$316.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$158.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.96
|
|
|
CH LONG CHAIN FATTY ACID
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
HCPCS 82726
|
| Hospital Charge Code |
397073353
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$158.25 |
| Max. Negotiated Rate |
$158.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$158.25
|
|
|
CHLORAL HYDRATE 325 MG SUPP
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
60629113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$9.12
|
| Rate for Payer: Aetna Medicare Advantage |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.12
|
| Rate for Payer: Cigna Commercial |
$12.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.20
|
| Rate for Payer: Oxford Commercial |
$4.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.64
|
|
|
CHLORAL HYDRATE 325 MG SUPP
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
60629113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.60
|
|
|
CHLORAL HYDRATE 500MG
|
Facility
|
IP
|
$1.95
|
|
| Hospital Charge Code |
6020044
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
|
|
CHLORAL HYDRATE 500MG
|
Facility
|
OP
|
$1.95
|
|
| Hospital Charge Code |
6020044
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna Commercial |
$0.74
|
| Rate for Payer: Aetna Medicare Advantage |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.59
|
| Rate for Payer: Oxford Commercial |
$0.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.39
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.05
|
|
|
CHLORAL HYDRATE 500MG/5ML
|
Facility
|
IP
|
$5.65
|
|
| Hospital Charge Code |
6021182
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.85
|
|
|
CHLORAL HYDRATE 500MG/5ML
|
Facility
|
OP
|
$5.65
|
|
| Hospital Charge Code |
6021182
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna Commercial |
$2.15
|
| Rate for Payer: Aetna Medicare Advantage |
$1.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.44
|
| Rate for Payer: Cigna Commercial |
$2.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.70
|
| Rate for Payer: Oxford Commercial |
$1.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.13
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.15
|
|
|
CHLORAL HYDRATE/500MG/5ML
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
60634414
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.20
|
|
|
CHLORAL HYDRATE/500MG/5ML
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
60634414
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna Commercial |
$10.64
|
| Rate for Payer: Aetna Medicare Advantage |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.14
|
| Rate for Payer: Cigna Commercial |
$14.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.40
|
| Rate for Payer: Oxford Commercial |
$5.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.74
|
|
