|
CH MIX LYMPHOCYTE CULT
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
HCPCS 86813
|
| Hospital Charge Code |
397031074
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Aetna Commercial |
$157.76
|
| Rate for Payer: Aetna Medicare Advantage |
$187.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$209.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$209.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$58.00
|
| 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 |
$209.36
|
| Rate for Payer: Cigna Commercial |
$454.50
|
| Rate for Payer: Cigna Medicare Advantage |
$58.00
|
| Rate for Payer: Clover Medicare Advantage |
$55.10
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Humana Medicare Advantage |
$59.74
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$58.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$58.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$58.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.09
|
|
|
CH MIX LYMPHOCYTE CULT
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
HCPCS 86813
|
| Hospital Charge Code |
397031074
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$136.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.35
|
|
|
CH MMR VZV PROFILE EIA
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
397071366
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$23.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.85
|
|
|
CH MMR VZV PROFILE EIA
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
397071366
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.21 |
| 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 |
$79.50
|
| 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 |
$47.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.85
|
| 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 |
$4.21
|
|
|
CH MOLD ALLERGY PROFILE
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397073680
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.84
|
| Rate for Payer: Cigna Commercial |
$39.50
|
| Rate for Payer: Cigna Medicare Advantage |
$5.22
|
| Rate for Payer: Clover Medicare Advantage |
$4.96
|
| Rate for Payer: EmblemHealth Commercial |
$15.66
|
| Rate for Payer: Humana Medicare Advantage |
$5.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.09
|
|
|
CH MOLD ALLERGY PROFILE
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397073680
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$11.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.85
|
|
|
CH MOLECULE MUTATION SCAN
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 83903
|
| Hospital Charge Code |
397071199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$16.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.95
|
|
|
CH MOLECULE MUTATION SCAN
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 83903
|
| Hospital Charge Code |
397071199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$42.94
|
| Rate for Payer: Aetna Medicare Advantage |
$33.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.82
|
| Rate for Payer: Cigna Commercial |
$56.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.99
|
|
|
CH MOLE NUCLEIC AMPLI 2 SEQ
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 81225
|
| Hospital Charge Code |
397073654
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.90
|
|
|
CH MOLE NUCLEIC AMPLI 2 SEQ
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 81225
|
| Hospital Charge Code |
397073654
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$1,051.72 |
| Rate for Payer: Aetna Commercial |
$792.50
|
| Rate for Payer: Aetna Medicare Advantage |
$944.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,051.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,051.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$291.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,051.72
|
| Rate for Payer: Cigna Commercial |
$63.00
|
| Rate for Payer: Cigna Medicare Advantage |
$291.36
|
| Rate for Payer: Clover Medicare Advantage |
$276.79
|
| Rate for Payer: EmblemHealth Commercial |
$874.08
|
| Rate for Payer: Humana Medicare Advantage |
$300.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$291.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$233.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$291.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$291.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.34
|
|
|
CH MOLYBDENUM
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
397071511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$59.73
|
| Rate for Payer: Aetna Medicare Advantage |
$71.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.27
|
| Rate for Payer: Cigna Commercial |
$96.50
|
| Rate for Payer: Cigna Medicare Advantage |
$21.96
|
| Rate for Payer: Clover Medicare Advantage |
$20.86
|
| Rate for Payer: EmblemHealth Commercial |
$65.88
|
| Rate for Payer: Humana Medicare Advantage |
$22.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.57
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.11
|
|
|
CH MOLYBDENUM
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
397071511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.95
|
|
|
CH MONONUCLEAR CELL ANTIGEN
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 86356
|
| Hospital Charge Code |
397073663
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$72.84
|
| Rate for Payer: Aetna Medicare Advantage |
$86.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$96.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$96.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$96.67
|
| Rate for Payer: Cigna Commercial |
$94.50
|
| Rate for Payer: Cigna Medicare Advantage |
$26.78
|
| Rate for Payer: Clover Medicare Advantage |
$25.44
|
| Rate for Payer: EmblemHealth Commercial |
$80.34
|
| Rate for Payer: Humana Medicare Advantage |
$27.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$26.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.01
|
|
|
CH MONONUCLEAR CELL ANTIGEN
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 86356
|
| Hospital Charge Code |
397073663
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$28.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.35
|
|
|
CH MONOSCREEN
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
397041088
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH MONOSCREEN
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
397041088
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$14.09
|
| Rate for Payer: Aetna Medicare Advantage |
$16.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.18
|
| 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 |
$18.70
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$5.18
|
| Rate for Payer: Clover Medicare Advantage |
$4.92
|
| Rate for Payer: EmblemHealth Commercial |
$15.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.18
|
| 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 |
$4.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
CH M. PNEUMONIAE AB (IGM)
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
397071427
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.80
|
|
|
CH M. PNEUMONIAE AB (IGM)
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
397071427
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$36.01
|
| Rate for Payer: Aetna Medicare Advantage |
$42.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.79
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.24
|
| Rate for Payer: Clover Medicare Advantage |
$12.58
|
| Rate for Payer: EmblemHealth Commercial |
$39.72
|
| Rate for Payer: Humana Medicare Advantage |
$13.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.80
|
|
|
CH M TUBERCULOSIS SENSITIVTY
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
HCPCS 87190
|
| Hospital Charge Code |
397071385
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$19.88
|
| Rate for Payer: Aetna Medicare Advantage |
$23.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.39
|
| Rate for Payer: Cigna Commercial |
$192.00
|
| Rate for Payer: Cigna Medicare Advantage |
$7.31
|
| Rate for Payer: Clover Medicare Advantage |
$6.94
|
| Rate for Payer: EmblemHealth Commercial |
$21.93
|
| Rate for Payer: Humana Medicare Advantage |
$7.53
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$115.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.85
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.18
|
|
|
CH M TUBERCULOSIS SENSITIVTY
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
HCPCS 87190
|
| Hospital Charge Code |
397071385
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.60
|
|
|
CH MUMPS AB IGG
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
397041188
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
|
|
CH MUMPS AB IGG
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
397041188
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.50
|
| Rate for Payer: Aetna Medicare Advantage |
$42.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.05
|
| 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 |
$47.11
|
| Rate for Payer: Cigna Commercial |
$99.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.05
|
| Rate for Payer: Clover Medicare Advantage |
$12.40
|
| Rate for Payer: EmblemHealth Commercial |
$39.15
|
| Rate for Payer: Humana Medicare Advantage |
$13.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.25
|
|
|
CH MUSK AB
|
Facility
|
IP
|
$3,185.70
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397071431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$477.86 |
| Max. Negotiated Rate |
$477.86 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$477.86
|
|
|
CH MUSK AB
|
Facility
|
OP
|
$3,185.70
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397071431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$1,592.85 |
| 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 |
$1,592.85
|
| 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 |
$955.71
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$477.86
|
| 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 |
$84.42
|
|
|
CH MUTATION ID OLA/SBCE/ASPE
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 83914
|
| Hospital Charge Code |
397071418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$38.38
|
| Rate for Payer: Aetna Medicare Advantage |
$30.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.75
|
| Rate for Payer: Cigna Commercial |
$50.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.68
|
|
