|
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
|
|
|
CH MUTATION SEQUENCE X8
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 83904
|
| Hospital Charge Code |
397073574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$39.52
|
| Rate for Payer: Aetna Medicare Advantage |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.52
|
| Rate for Payer: Cigna Commercial |
$52.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.76
|
|
|
CH MUTATION SEQUENCE X8
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 83904
|
| Hospital Charge Code |
397073574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.60
|
|
|
CH MYASTHENIA GRAVIS EVAL
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397073205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$266.00 |
| 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 |
$266.00
|
| 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 |
$159.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.80
|
| 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 |
$14.10
|
|
|
CH MYASTHENIA GRAVIS EVAL
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397073205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.80
|
|
|
CH MYCOBACTERIUM TB DNAPCR B
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
397073558
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: Aetna Commercial |
$113.37
|
| Rate for Payer: Aetna Medicare Advantage |
$135.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$150.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$150.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$41.68
|
| 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 |
$150.45
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Cigna Medicare Advantage |
$41.68
|
| Rate for Payer: Clover Medicare Advantage |
$39.60
|
| Rate for Payer: EmblemHealth Commercial |
$125.04
|
| Rate for Payer: Humana Medicare Advantage |
$42.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$41.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$41.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.88
|
|
|
CH MYCOBACTERIUM TB DNAPCR B
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
397073558
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.60
|
|
|
CH MYCOPHENOLIC ACID
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
397071386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$196.50 |
| Rate for Payer: Aetna Commercial |
$65.58
|
| Rate for Payer: Aetna Medicare Advantage |
$78.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.11
|
| 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 |
$87.03
|
| Rate for Payer: Cigna Commercial |
$196.50
|
| Rate for Payer: Cigna Medicare Advantage |
$24.11
|
| Rate for Payer: Clover Medicare Advantage |
$22.90
|
| Rate for Payer: EmblemHealth Commercial |
$72.33
|
| Rate for Payer: Humana Medicare Advantage |
$24.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.41
|
|
|
CH MYCOPHENOLIC ACID
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
397071386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.95 |
| Max. Negotiated Rate |
$58.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.95
|
|
|
CH MYCOPLASMA IGM
|
Facility
|
OP
|
$66.20
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
397043216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$33.10
|
| 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 |
$19.86
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.93
|
| 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 |
$1.75
|
|
|
CH MYCOPLASMA IGM
|
Facility
|
IP
|
$66.20
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
397043216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$9.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.93
|
|
|
CH MYELIN BASIC PROTEIN
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
397073231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.90 |
| Max. Negotiated Rate |
$93.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.90
|
|
|
CH MYELIN BASIC PROTEIN
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
397073231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$313.00 |
| Rate for Payer: Aetna Commercial |
$46.78
|
| Rate for Payer: Aetna Medicare Advantage |
$55.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.09
|
| Rate for Payer: Cigna Commercial |
$313.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.20
|
| Rate for Payer: Clover Medicare Advantage |
$16.34
|
| Rate for Payer: EmblemHealth Commercial |
$51.60
|
| Rate for Payer: Humana Medicare Advantage |
$17.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.59
|
|
|
CH MYELIN BASIC PROTEIN
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
397071049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$69.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.60
|
|
|
CH MYELIN BASIC PROTEIN
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
397071049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$232.00 |
| Rate for Payer: Aetna Commercial |
$46.78
|
| Rate for Payer: Aetna Medicare Advantage |
$55.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$55.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.09
|
| Rate for Payer: Cigna Commercial |
$232.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.20
|
| Rate for Payer: Clover Medicare Advantage |
$16.34
|
| Rate for Payer: EmblemHealth Commercial |
$51.60
|
| Rate for Payer: Humana Medicare Advantage |
$17.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.30
|
|
|
CH MYOGLOBIN, SERUM
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
397072115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare Advantage |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.64
|
| Rate for Payer: Cigna Commercial |
$103.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.92
|
| Rate for Payer: Clover Medicare Advantage |
$12.27
|
| Rate for Payer: EmblemHealth Commercial |
$38.76
|
| Rate for Payer: Humana Medicare Advantage |
$13.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.92
|
| 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 |
$10.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.49
|
|
|
CH MYOGLOBIN, SERUM
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
397072115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
|
|
CH MYOGLOBIN URINE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
397071047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
CH MYOGLOBIN URINE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
397071047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare Advantage |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.64
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.92
|
| Rate for Payer: Clover Medicare Advantage |
$12.27
|
| Rate for Payer: EmblemHealth Commercial |
$38.76
|
| Rate for Payer: Humana Medicare Advantage |
$13.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.31
|
|
|
CH NAPA
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 80192
|
| Hospital Charge Code |
397071243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$45.56
|
| Rate for Payer: Aetna Medicare Advantage |
$54.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.75
|
| 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 |
$60.46
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.75
|
| Rate for Payer: Clover Medicare Advantage |
$15.91
|
| Rate for Payer: EmblemHealth Commercial |
$50.25
|
| Rate for Payer: Humana Medicare Advantage |
$17.25
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.08
|
|
|
CH NAPA
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 80192
|
| Hospital Charge Code |
397071243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
CH NAPROTILINE
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
|
|
CH NAPROTILINE
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073139
|
|
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 NEFAZDONE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397071358
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
|
|
CH NEFAZDONE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397071358
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.77 |
| 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 |
$90.00
|
| 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 |
$54.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
| 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 |
$4.77
|
|
