|
CH LYMPHOCYTE SUBSETS
|
Facility
|
OP
|
$2,063.00
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
397021286
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.58 |
| Max. Negotiated Rate |
$1,031.50 |
| Rate for Payer: Aetna Commercial |
$127.79
|
| Rate for Payer: Aetna Medicare Advantage |
$152.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.58
|
| Rate for Payer: Cigna Commercial |
$1,031.50
|
| Rate for Payer: Cigna Medicare Advantage |
$46.98
|
| Rate for Payer: Clover Medicare Advantage |
$44.63
|
| Rate for Payer: EmblemHealth Commercial |
$140.94
|
| Rate for Payer: Humana Medicare Advantage |
$48.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$46.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$618.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$309.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$37.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$46.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$54.67
|
|
|
CH LYSOZOME SERUM
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
397072104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$24.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.60
|
|
|
CH LYSOZOME SERUM
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
397072104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.68
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.75
|
| Rate for Payer: Clover Medicare Advantage |
$17.81
|
| Rate for Payer: EmblemHealth Commercial |
$56.25
|
| Rate for Payer: Humana Medicare Advantage |
$19.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.35
|
|
|
CH LYSOZYME URINE
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
397071053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.45 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.45
|
|
|
CH LYSOZYME URINE
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
397071053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.68
|
| Rate for Payer: Cigna Commercial |
$61.50
|
| Rate for Payer: Cigna Medicare Advantage |
$18.75
|
| Rate for Payer: Clover Medicare Advantage |
$17.81
|
| Rate for Payer: EmblemHealth Commercial |
$56.25
|
| Rate for Payer: Humana Medicare Advantage |
$19.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.26
|
|
|
CH MACRODENTIN
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.55
|
|
|
CH MACRODENTIN
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.75 |
| 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 |
$108.50
|
| 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 |
$65.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.55
|
| 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 |
$5.75
|
|
|
CH MAGNESIUM
|
Facility
|
OP
|
$199.90
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
397071295
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Medicare Advantage |
$21.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.18
|
| Rate for Payer: Cigna Commercial |
$99.95
|
| Rate for Payer: Cigna Medicare Advantage |
$6.70
|
| Rate for Payer: Clover Medicare Advantage |
$6.37
|
| Rate for Payer: EmblemHealth Commercial |
$20.10
|
| Rate for Payer: Humana Medicare Advantage |
$6.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.97
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.30
|
|
|
CH MAGNESIUM
|
Facility
|
IP
|
$199.90
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
397071295
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$29.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.98
|
|
|
CH MAGNESIUM URINE 24HR
|
Facility
|
IP
|
$199.90
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
397073103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$29.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.98
|
|
|
CH MAGNESIUM URINE 24HR
|
Facility
|
OP
|
$199.90
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
397073103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$18.22
|
| Rate for Payer: Aetna Medicare Advantage |
$21.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.18
|
| Rate for Payer: Cigna Commercial |
$99.95
|
| Rate for Payer: Cigna Medicare Advantage |
$6.70
|
| Rate for Payer: Clover Medicare Advantage |
$6.37
|
| Rate for Payer: EmblemHealth Commercial |
$20.10
|
| Rate for Payer: Humana Medicare Advantage |
$6.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.97
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.30
|
|
|
CH MALARIA SMEAR
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
397021028
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH MALARIA SMEAR
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
397021028
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna Medicare Advantage |
$19.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.99
|
| 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 |
$21.62
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.99
|
| Rate for Payer: Clover Medicare Advantage |
$5.69
|
| Rate for Payer: EmblemHealth Commercial |
$17.97
|
| Rate for Payer: Humana Medicare Advantage |
$6.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.99
|
| 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 |
$4.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH MAMMAGLOBIN 1ST
|
Facility
|
OP
|
$1,082.30
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
397061371
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$730.60 |
| Rate for Payer: Aetna Commercial |
$550.53
|
| Rate for Payer: Aetna Medicare Advantage |
$655.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$730.60
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$202.40
|
| Rate for Payer: Clover Medicare Advantage |
$192.28
|
| Rate for Payer: EmblemHealth Commercial |
$607.20
|
| Rate for Payer: Humana Medicare Advantage |
$208.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$202.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$324.69
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$86.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.68
|
|
|
CH MAMMAGLOBIN 1ST
|
Facility
|
IP
|
$1,082.30
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
397061371
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$162.34 |
| Max. Negotiated Rate |
$162.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.34
|
|
|
CH MEASLES AB (IGG) QUANT
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
397071412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$21.00
|
| 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 |
$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 |
$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 |
$1.11
|
|
|
CH MEASLES AB (IGG) QUANT
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
397071412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.30
|
|
|
CH MEASLES ABS IGG, IGM
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
397071400
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| 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 |
$60.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
| 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 |
$5.30
|
|
|
CH MEASLES ABS IGG, IGM
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
397071400
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
CH MEGALOBLASTIC ANEMIA
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397072105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$499.00 |
| 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 |
$499.00
|
| 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 |
$299.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.70
|
| 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 |
$26.45
|
|
|
CH MEGALOBLASTIC ANEMIA
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397072105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$149.70 |
| Max. Negotiated Rate |
$149.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.70
|
|
|
CH MELANIN QUAL U
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 84999
|
| Hospital Charge Code |
397072106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Medicare Advantage |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.60
|
| Rate for Payer: Cigna Commercial |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.18
|
|
|
CH MELANIN QUAL U
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 84999
|
| Hospital Charge Code |
397072106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.00
|
|
|
CH MELANOCYTE STIM HORMONE
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397073075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Aetna Medicare Advantage |
$59.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.42
|
| Rate for Payer: Cigna Commercial |
$119.50
|
| Rate for Payer: Cigna Medicare Advantage |
$18.40
|
| Rate for Payer: Clover Medicare Advantage |
$17.48
|
| Rate for Payer: EmblemHealth Commercial |
$55.20
|
| Rate for Payer: Humana Medicare Advantage |
$18.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.33
|
|
|
CH MELANOCYTE STIM HORMONE
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397073075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$35.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.85
|
|
