|
CH METHANOL, BLOOD
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
397072157
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$46.54
|
| Rate for Payer: Aetna Medicare Advantage |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.76
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$17.11
|
| Rate for Payer: Clover Medicare Advantage |
$16.25
|
| Rate for Payer: EmblemHealth Commercial |
$51.33
|
| Rate for Payer: Humana Medicare Advantage |
$17.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.11
|
| 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 |
$13.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
CH METHOTREXATE
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397071018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$129.00 |
| 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 |
$129.00
|
| 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 |
$77.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.70
|
| 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 |
$6.84
|
|
|
CH METHOTREXATE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397071018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.70
|
|
|
CH METHQUALONE CONF
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
HCPCS 80300
|
| Hospital Charge Code |
397073158
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$347.50 |
| Rate for Payer: Aetna Commercial |
$264.10
|
| Rate for Payer: Aetna Medicare Advantage |
$208.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$177.22
|
| Rate for Payer: Cigna Commercial |
$347.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.42
|
|
|
CH METHQUALONE CONF
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
HCPCS 80300
|
| Hospital Charge Code |
397073158
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
|
|
CH METHYLMALONIC ACID
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
HCPCS 83921
|
| Hospital Charge Code |
397072112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Aetna Commercial |
$57.69
|
| Rate for Payer: Aetna Medicare Advantage |
$68.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.56
|
| Rate for Payer: Cigna Commercial |
$178.50
|
| Rate for Payer: Cigna Medicare Advantage |
$21.21
|
| Rate for Payer: Clover Medicare Advantage |
$20.15
|
| Rate for Payer: EmblemHealth Commercial |
$63.63
|
| Rate for Payer: Humana Medicare Advantage |
$21.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$107.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.97
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.46
|
|
|
CH METHYLMALONIC ACID
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
HCPCS 83921
|
| Hospital Charge Code |
397072112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.55
|
|
|
CH METHYLMALONIC ACID
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
HCPCS 83918
|
| Hospital Charge Code |
397073275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Aetna Commercial |
$64.19
|
| Rate for Payer: Aetna Medicare Advantage |
$76.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$85.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$85.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$23.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$85.19
|
| Rate for Payer: Cigna Commercial |
$178.50
|
| Rate for Payer: Cigna Medicare Advantage |
$23.60
|
| Rate for Payer: Clover Medicare Advantage |
$22.42
|
| Rate for Payer: EmblemHealth Commercial |
$70.80
|
| Rate for Payer: Humana Medicare Advantage |
$24.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$23.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$107.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$23.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.46
|
|
|
CH METHYLMALONIC ACID
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
HCPCS 83918
|
| Hospital Charge Code |
397073275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.55
|
|
|
CH METHYLMALONIC ACID. SERUM
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 83921
|
| Hospital Charge Code |
397070002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.40
|
|
|
CH METHYLMALONIC ACID. SERUM
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 83921
|
| Hospital Charge Code |
397070002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$57.69
|
| Rate for Payer: Aetna Medicare Advantage |
$68.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.56
|
| Rate for Payer: Cigna Commercial |
$88.00
|
| Rate for Payer: Cigna Medicare Advantage |
$21.21
|
| Rate for Payer: Clover Medicare Advantage |
$20.15
|
| Rate for Payer: EmblemHealth Commercial |
$63.63
|
| Rate for Payer: Humana Medicare Advantage |
$21.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.97
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.66
|
|
|
CH MEXILETINE
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397072113
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
|
|
CH MEXILETINE
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397072113
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| 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 |
$42.50
|
| 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 |
$25.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
| 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 |
$2.25
|
|
|
CH MI 2 AUTOANTIBODIES
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
397071521
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$35.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.85
|
|
|
CH MI 2 AUTOANTIBODIES
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
397071521
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: Aetna Medicare Advantage |
$58.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.72
|
| Rate for Payer: Cigna Commercial |
$119.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.93
|
| Rate for Payer: Clover Medicare Advantage |
$17.03
|
| Rate for Payer: EmblemHealth Commercial |
$53.79
|
| Rate for Payer: Humana Medicare Advantage |
$18.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.93
|
| 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 |
$14.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.33
|
|
|
CH MICROALB/RANDOM UCREAT
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
397073635
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$211.00 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare Advantage |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.86
|
| Rate for Payer: Cigna Commercial |
$211.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.78
|
| Rate for Payer: Clover Medicare Advantage |
$5.49
|
| Rate for Payer: EmblemHealth Commercial |
$17.34
|
| Rate for Payer: Humana Medicare Advantage |
$5.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$126.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.18
|
|
|
CH MICROALB/RANDOM UCREAT
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
397073635
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$63.30 |
| Max. Negotiated Rate |
$63.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.30
|
|
|
CH MICROALBUMIN 24HR URIN
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
397073622
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$63.30 |
| Max. Negotiated Rate |
$63.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.30
|
|
|
CH MICROALBUMIN 24HR URIN
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
397073622
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$211.00 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare Advantage |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.86
|
| Rate for Payer: Cigna Commercial |
$211.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.78
|
| Rate for Payer: Clover Medicare Advantage |
$5.49
|
| Rate for Payer: EmblemHealth Commercial |
$17.34
|
| Rate for Payer: Humana Medicare Advantage |
$5.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$126.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.18
|
|
|
CH MICROALBUMIN 24H URINE
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
397072012
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$63.30 |
| Max. Negotiated Rate |
$63.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.30
|
|
|
CH MICROALBUMIN 24H URINE
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
397072012
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$211.00 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare Advantage |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.86
|
| Rate for Payer: Cigna Commercial |
$211.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.78
|
| Rate for Payer: Clover Medicare Advantage |
$5.49
|
| Rate for Payer: EmblemHealth Commercial |
$17.34
|
| Rate for Payer: Humana Medicare Advantage |
$5.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$126.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.18
|
|
|
CH MICROALBUMIN,RANDOM URINE
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
397071360
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$211.00 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare Advantage |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.86
|
| Rate for Payer: Cigna Commercial |
$211.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.78
|
| Rate for Payer: Clover Medicare Advantage |
$5.49
|
| Rate for Payer: EmblemHealth Commercial |
$17.34
|
| Rate for Payer: Humana Medicare Advantage |
$5.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$126.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.18
|
|
|
CH MICROALBUMIN,RANDOM URINE
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
397071360
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$63.30 |
| Max. Negotiated Rate |
$63.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.30
|
|
|
CH MICROSPORIDIA ID (STOOL)
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
397071409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$21.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.90
|
|
|
CH MICROSPORIDIA ID (STOOL)
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
397071409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$18.17
|
| Rate for Payer: Aetna Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.11
|
| Rate for Payer: Cigna Commercial |
$73.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.68
|
| Rate for Payer: Clover Medicare Advantage |
$6.35
|
| Rate for Payer: EmblemHealth Commercial |
$20.04
|
| Rate for Payer: Humana Medicare Advantage |
$6.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.87
|
|
