|
CH NEISSERIA GONORRHOEAE AB
|
Facility
|
IP
|
$64.40
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
397040025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.66
|
|
|
CH NEISSERIA GONORRHOEAE AB
|
Facility
|
OP
|
$64.40
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
397040025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.71 |
| 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 |
$32.20
|
| 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 |
$19.32
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.66
|
| 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 |
$1.71
|
|
|
CH NEUROFIBROMATUS TYPE DNA
|
Facility
|
OP
|
$7,723.00
|
|
|
Service Code
|
HCPCS 86849
|
| Hospital Charge Code |
397073346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$3,861.50 |
| Rate for Payer: Aetna Commercial |
$2,934.74
|
| Rate for Payer: Aetna Medicare Advantage |
$2,316.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,969.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,969.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,969.37
|
| Rate for Payer: Cigna Commercial |
$3,861.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,316.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,158.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$186.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$204.66
|
|
|
CH NEUROFIBROMATUS TYPE DNA
|
Facility
|
IP
|
$7,723.00
|
|
|
Service Code
|
HCPCS 86849
|
| Hospital Charge Code |
397073346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1,158.45 |
| Max. Negotiated Rate |
$1,158.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,158.45
|
|
|
CH NEURON SPECIFIC ENOLASE
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
397072116
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.90
|
|
|
CH NEURON SPECIFIC ENOLASE
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
397072116
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare Advantage |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.81
|
| 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 |
$75.12
|
| Rate for Payer: Cigna Commercial |
$63.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.81
|
| Rate for Payer: Clover Medicare Advantage |
$19.77
|
| Rate for Payer: EmblemHealth Commercial |
$62.43
|
| Rate for Payer: Humana Medicare Advantage |
$21.43
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.81
|
| 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 |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.34
|
|
|
CH NEURONTIN
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397071303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$132.00 |
| 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 |
$132.00
|
| 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 |
$79.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.60
|
| 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 |
$7.00
|
|
|
CH NEURONTIN
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397071303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.60
|
|
|
CH N GONORRHEAE AB,CF SERUM
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
397071504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.15 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.15
|
|
|
CH N GONORRHEAE AB,CF SERUM
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
397071504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$210.50 |
| 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 |
$210.50
|
| 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 |
$126.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.15
|
| 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 |
$11.16
|
|
|
CH N.GONORRHOEA DNA AMP PROB
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
397071487
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
|
|
CH N.GONORRHOEA DNA AMP PROB
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
397071487
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.57 |
| 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 |
$72.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$105.00
|
| 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 |
$63.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
| 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 |
$5.57
|
|
|
CH NHP22
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
397073202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$35.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.55
|
|
|
CH NHP22
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
397073202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare Advantage |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.81
|
| 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 |
$75.12
|
| Rate for Payer: Cigna Commercial |
$118.50
|
| Rate for Payer: Cigna Medicare Advantage |
$20.81
|
| Rate for Payer: Clover Medicare Advantage |
$19.77
|
| Rate for Payer: EmblemHealth Commercial |
$62.43
|
| Rate for Payer: Humana Medicare Advantage |
$21.43
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.28
|
|
|
CH NICOTINE
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
HCPCS 80323
|
| Hospital Charge Code |
397021301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.95
|
|
|
CH NICOTINE
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
HCPCS 80323
|
| Hospital Charge Code |
397021301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$88.54
|
| Rate for Payer: Aetna Medicare Advantage |
$69.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.41
|
| Rate for Payer: Cigna Commercial |
$116.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$69.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.17
|
|
|
CH NITRO BLUE TETRAZOLIUM
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS 82657
|
| Hospital Charge Code |
397072158
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$289.50 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Medicare Advantage |
$71.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$80.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$80.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$80.03
|
| Rate for Payer: Cigna Commercial |
$289.50
|
| Rate for Payer: Cigna Medicare Advantage |
$22.17
|
| Rate for Payer: Clover Medicare Advantage |
$21.06
|
| Rate for Payer: EmblemHealth Commercial |
$66.51
|
| Rate for Payer: Humana Medicare Advantage |
$22.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.34
|
|
|
CH NITRO BLUE TETRAZOLIUM
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS 82657
|
| Hospital Charge Code |
397072158
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.85 |
| Max. Negotiated Rate |
$86.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.85
|
|
|
CH NMO, IGG AB, ELISA
|
Facility
|
OP
|
$407.20
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
397070024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$203.60 |
| Rate for Payer: Aetna Commercial |
$31.36
|
| Rate for Payer: Aetna Medicare Advantage |
$37.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.53
|
| 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 |
$41.62
|
| Rate for Payer: Cigna Commercial |
$203.60
|
| Rate for Payer: Cigna Medicare Advantage |
$11.53
|
| Rate for Payer: Clover Medicare Advantage |
$10.95
|
| Rate for Payer: EmblemHealth Commercial |
$34.59
|
| Rate for Payer: Humana Medicare Advantage |
$11.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.16
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.79
|
|
|
CH NMO, IGG AB, ELISA
|
Facility
|
IP
|
$407.20
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
397070024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.08 |
| Max. Negotiated Rate |
$61.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.08
|
|
|
CH NMO,IGG AB, ELISA
|
Facility
|
OP
|
$1,171.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
397071533
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$585.50 |
| Rate for Payer: Aetna Commercial |
$31.36
|
| Rate for Payer: Aetna Medicare Advantage |
$37.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.53
|
| 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 |
$41.62
|
| Rate for Payer: Cigna Commercial |
$585.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.53
|
| Rate for Payer: Clover Medicare Advantage |
$10.95
|
| Rate for Payer: EmblemHealth Commercial |
$34.59
|
| Rate for Payer: Humana Medicare Advantage |
$11.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$351.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.03
|
|
|
CH NMO,IGG AB, ELISA
|
Facility
|
IP
|
$1,171.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
397071533
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$175.65 |
| Max. Negotiated Rate |
$175.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.65
|
|
|
CH NON FORMULAY CHARGE
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 0
|
| Hospital Charge Code |
606351008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
CH NON FORMULAY CHARGE
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 0
|
| Hospital Charge Code |
606351008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.20
|
| Rate for Payer: Oxford Commercial |
$0.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.11
|
|
|
CH NOREPINEPHRINE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
397073630
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Medicare Advantage |
$78.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.09
|
| 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 |
$86.96
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.09
|
| Rate for Payer: Clover Medicare Advantage |
$22.89
|
| Rate for Payer: EmblemHealth Commercial |
$72.27
|
| Rate for Payer: Humana Medicare Advantage |
$24.81
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.09
|
| 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 |
$19.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
