|
CH PLATELETS RANDOM LEUKORED
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
397031161
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.90
|
|
|
CH PLATELETS RAN LEUKO IRRAD
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
397031162
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$599.65
|
| Rate for Payer: Aetna Medicare Advantage |
$714.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$795.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$795.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$220.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$795.79
|
| Rate for Payer: Cigna Commercial |
$441.93
|
| Rate for Payer: Cigna Medicare Advantage |
$220.46
|
| Rate for Payer: Clover Medicare Advantage |
$209.44
|
| Rate for Payer: EmblemHealth Commercial |
$661.38
|
| Rate for Payer: Humana Medicare Advantage |
$227.07
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$220.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$210.30
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.89
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$220.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$220.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.58
|
|
|
CH PLATELETS RAN LEUKO IRRAD
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
397031162
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$105.15 |
| Max. Negotiated Rate |
$105.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.15
|
|
|
CH PLETS PHER LEUK CMV NEG
|
Facility
|
IP
|
$2,518.60
|
|
|
Service Code
|
HCPCS P9055
|
| Hospital Charge Code |
397031170
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$377.79 |
| Max. Negotiated Rate |
$377.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$377.79
|
|
|
CH PLETS PHER LEUK CMV NEG
|
Facility
|
OP
|
$2,518.60
|
|
|
Service Code
|
HCPCS P9055
|
| Hospital Charge Code |
397031170
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$792.28
|
| Rate for Payer: Aetna Medicare Advantage |
$943.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,051.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,051.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$291.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,051.43
|
| Rate for Payer: Cigna Commercial |
$583.86
|
| Rate for Payer: Cigna Medicare Advantage |
$291.28
|
| Rate for Payer: Clover Medicare Advantage |
$276.72
|
| Rate for Payer: EmblemHealth Commercial |
$873.84
|
| Rate for Payer: Humana Medicare Advantage |
$300.02
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$291.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$755.58
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$377.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$60.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$291.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$291.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$66.74
|
|
|
CH PLT COUNT MANUAL
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 85032
|
| Hospital Charge Code |
397021075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
|
|
CH PLT COUNT MANUAL
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 85032
|
| Hospital Charge Code |
397021075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$11.72
|
| Rate for Payer: Aetna Medicare Advantage |
$13.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.31
|
| 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 |
$15.56
|
| Rate for Payer: Cigna Commercial |
$30.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.31
|
| Rate for Payer: Clover Medicare Advantage |
$4.09
|
| Rate for Payer: EmblemHealth Commercial |
$12.93
|
| Rate for Payer: Humana Medicare Advantage |
$4.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.59
|
|
|
CH PLTS PH LEUK CMV NEG IRRD
|
Facility
|
IP
|
$4,463.55
|
|
|
Service Code
|
HCPCS P9053
|
| Hospital Charge Code |
397031168
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$669.53 |
| Max. Negotiated Rate |
$669.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$669.53
|
|
|
CH PLTS PH LEUK CMV NEG IRRD
|
Facility
|
OP
|
$4,463.55
|
|
|
Service Code
|
HCPCS P9053
|
| Hospital Charge Code |
397031168
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$2,113.23 |
| Rate for Payer: Aetna Commercial |
$1,592.37
|
| Rate for Payer: Aetna Medicare Advantage |
$1,896.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,113.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,113.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$585.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,113.23
|
| Rate for Payer: Cigna Commercial |
$1,173.50
|
| Rate for Payer: Cigna Medicare Advantage |
$585.43
|
| Rate for Payer: Clover Medicare Advantage |
$556.16
|
| Rate for Payer: EmblemHealth Commercial |
$1,756.29
|
| Rate for Payer: Humana Medicare Advantage |
$602.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$585.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,339.07
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$669.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$107.57
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$585.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$585.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$118.28
|
|
|
CH PM-SCL ANTIBODY
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
397071522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.13 |
| 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 |
$59.00
|
| 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 |
$35.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.70
|
| 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 |
$3.13
|
|
|
CH PM-SCL ANTIBODY
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
397071522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.70
|
|
|
CH POOLED PLASMA SD TREATED
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS P9023
|
| Hospital Charge Code |
397031150
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$109.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.65
|
|
|
CH POOLED PLASMA SD TREATED
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS P9023
|
| Hospital Charge Code |
397031150
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$176.99
|
| Rate for Payer: Aetna Medicare Advantage |
$210.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$234.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$234.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$65.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$234.88
|
| Rate for Payer: Cigna Commercial |
$130.43
|
| Rate for Payer: Cigna Medicare Advantage |
$65.07
|
| Rate for Payer: Clover Medicare Advantage |
$61.82
|
| Rate for Payer: EmblemHealth Commercial |
$195.21
|
| Rate for Payer: Humana Medicare Advantage |
$67.02
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$65.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.30
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$65.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.37
|
|
|
CH POOLING COMPONENT
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 86965
|
| Hospital Charge Code |
397031054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.31 |
| 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) NJ Health |
$58.08
|
| 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 |
$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 |
$25.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.31
|
|
|
CH POOLING COMPONENT
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 86965
|
| Hospital Charge Code |
397031054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
CH PORK (F26) IGE
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397071500
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.65
|
|
|
CH PORK (F26) IGE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397071500
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$0.82 |
| 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 |
$15.50
|
| 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 |
$9.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.65
|
| 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 |
$0.82
|
|
|
CH PORPHOBILINOGEN QUANT
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
397071253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
|
|
CH PORPHOBILINOGEN QUANT
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
397071253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$22.96
|
| Rate for Payer: Aetna Medicare Advantage |
$27.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.47
|
| Rate for Payer: Cigna Commercial |
$30.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.44
|
| Rate for Payer: Clover Medicare Advantage |
$8.02
|
| Rate for Payer: EmblemHealth Commercial |
$25.32
|
| Rate for Payer: Humana Medicare Advantage |
$8.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.59
|
|
|
CH PORPHYRINS QUANT & FRACT
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
HCPCS 84120
|
| Hospital Charge Code |
397071016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$40.01
|
| Rate for Payer: Aetna Medicare Advantage |
$47.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.10
|
| Rate for Payer: Cigna Commercial |
$168.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.71
|
| Rate for Payer: Clover Medicare Advantage |
$13.97
|
| Rate for Payer: EmblemHealth Commercial |
$44.13
|
| Rate for Payer: Humana Medicare Advantage |
$15.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.71
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.90
|
|
|
CH PORPHYRINS QUANT & FRACT
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
HCPCS 84120
|
| Hospital Charge Code |
397071016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.40
|
|
|
CH POTASSIUM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
397071105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Medicare Advantage |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.18
|
| Rate for Payer: Cigna Commercial |
$14.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.76
|
| Rate for Payer: Clover Medicare Advantage |
$4.52
|
| Rate for Payer: EmblemHealth Commercial |
$14.28
|
| Rate for Payer: Humana Medicare Advantage |
$4.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.81
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.74
|
|
|
CH POTASSIUM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
397071105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.20
|
|
|
CH POTASSIUM (RANDOM)
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
397073113
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.55
|
|
|
CH POTASSIUM (RANDOM)
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
397073113
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: Aetna Medicare Advantage |
$15.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.07
|
| Rate for Payer: Cigna Commercial |
$28.50
|
| Rate for Payer: Cigna Medicare Advantage |
$4.73
|
| Rate for Payer: Clover Medicare Advantage |
$4.49
|
| Rate for Payer: EmblemHealth Commercial |
$14.19
|
| Rate for Payer: Humana Medicare Advantage |
$4.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.51
|
|
