|
CH POTASSIUM URINE 24 HR
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
397071287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
CH POTASSIUM URINE 24 HR
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
397071287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.06 |
| 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 |
$20.00
|
| 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 |
$12.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| 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 |
$1.06
|
|
|
CH PRAZEPAM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| 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 |
$99.00
|
| 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 |
$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 |
$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 |
$5.25
|
|
|
CH PRAZEPAM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
|
|
CH PRE ALBUMIN
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
397073170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$39.68
|
| Rate for Payer: Aetna Medicare Advantage |
$47.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.59
|
| 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 |
$52.67
|
| Rate for Payer: Cigna Commercial |
$57.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.59
|
| Rate for Payer: Clover Medicare Advantage |
$13.86
|
| Rate for Payer: EmblemHealth Commercial |
$43.77
|
| Rate for Payer: Humana Medicare Advantage |
$15.03
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.02
|
|
|
CH PRE ALBUMIN
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
397073170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.10
|
|
|
CH PREGNANCY TEST URINE
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
397071116
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$44.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.40
|
|
|
CH PREGNANCY TEST URINE
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
397071116
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna Commercial |
$23.42
|
| Rate for Payer: Aetna Medicare Advantage |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.61
|
| 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 |
$31.08
|
| Rate for Payer: Cigna Commercial |
$148.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.61
|
| Rate for Payer: Clover Medicare Advantage |
$8.18
|
| Rate for Payer: EmblemHealth Commercial |
$25.83
|
| Rate for Payer: Humana Medicare Advantage |
$8.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.89
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.84
|
|
|
CH PREGNENOLONE, LC/MS/MS
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
HCPCS 84140
|
| Hospital Charge Code |
397071516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$186.50 |
| Rate for Payer: Aetna Commercial |
$56.22
|
| Rate for Payer: Aetna Medicare Advantage |
$66.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$74.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$74.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$74.61
|
| Rate for Payer: Cigna Commercial |
$186.50
|
| Rate for Payer: Cigna Medicare Advantage |
$20.67
|
| Rate for Payer: Clover Medicare Advantage |
$19.64
|
| Rate for Payer: EmblemHealth Commercial |
$62.01
|
| Rate for Payer: Humana Medicare Advantage |
$21.29
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$111.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.54
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.88
|
|
|
CH PREGNENOLONE, LC/MS/MS
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
HCPCS 84140
|
| Hospital Charge Code |
397071516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.95 |
| Max. Negotiated Rate |
$55.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.95
|
|
|
CH PRIMIDONE
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 80188
|
| Hospital Charge Code |
397071023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$45.12
|
| Rate for Payer: Aetna Medicare Advantage |
$53.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.59
|
| 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 |
$59.88
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.59
|
| Rate for Payer: Clover Medicare Advantage |
$15.76
|
| Rate for Payer: EmblemHealth Commercial |
$49.77
|
| Rate for Payer: Humana Medicare Advantage |
$17.09
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.21
|
|
|
CH PRIMIDONE
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 80188
|
| Hospital Charge Code |
397071023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.50
|
|
|
CH PROBNP
|
Facility
|
OP
|
$340.75
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
397073602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$170.38 |
| Rate for Payer: Aetna Commercial |
$106.79
|
| Rate for Payer: Aetna Medicare Advantage |
$127.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$141.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$141.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$39.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$141.72
|
| Rate for Payer: Cigna Commercial |
$170.38
|
| Rate for Payer: Cigna Medicare Advantage |
$39.26
|
| Rate for Payer: Clover Medicare Advantage |
$37.30
|
| Rate for Payer: EmblemHealth Commercial |
$117.78
|
| Rate for Payer: Humana Medicare Advantage |
$40.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$39.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.22
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.41
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$39.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$39.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.03
|
|
|
CH PROBNP
|
Facility
|
IP
|
$340.75
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
397073602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.11 |
| Max. Negotiated Rate |
$51.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.11
|
|
|
CH PROCAINAMIDE
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 80190
|
| Hospital Charge Code |
397071021
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.35
|
|
|
CH PROCAINAMIDE
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 80190
|
| Hospital Charge Code |
397071021
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$216.58 |
| Rate for Payer: Aetna Commercial |
$163.20
|
| Rate for Payer: Aetna Medicare Advantage |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$216.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$216.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$60.00
|
| 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 |
$216.58
|
| Rate for Payer: Cigna Commercial |
$84.50
|
| Rate for Payer: Cigna Medicare Advantage |
$60.00
|
| Rate for Payer: Clover Medicare Advantage |
$57.00
|
| Rate for Payer: EmblemHealth Commercial |
$180.00
|
| Rate for Payer: Humana Medicare Advantage |
$61.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$60.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.48
|
|
|
CH PROCALCITONIN SERUM
|
Facility
|
IP
|
$1,249.59
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
397073679
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$187.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.44
|
|
|
CH PROCALCITONIN SERUM
|
Facility
|
OP
|
$1,249.59
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
397073679
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.78 |
| Max. Negotiated Rate |
$624.79 |
| Rate for Payer: Aetna Commercial |
$74.04
|
| Rate for Payer: Aetna Medicare Advantage |
$88.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$98.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$98.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$27.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$98.26
|
| Rate for Payer: Cigna Commercial |
$624.79
|
| Rate for Payer: Cigna Medicare Advantage |
$27.22
|
| Rate for Payer: Clover Medicare Advantage |
$25.86
|
| Rate for Payer: EmblemHealth Commercial |
$81.66
|
| Rate for Payer: Humana Medicare Advantage |
$28.04
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$27.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$374.88
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$27.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.11
|
|
|
CH PROGESTERONE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
397071019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH PROGESTERONE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
397071019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$56.74
|
| Rate for Payer: Aetna Medicare Advantage |
$67.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.86
|
| 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 |
$75.30
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.86
|
| Rate for Payer: Clover Medicare Advantage |
$19.82
|
| Rate for Payer: EmblemHealth Commercial |
$62.58
|
| Rate for Payer: Humana Medicare Advantage |
$21.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.86
|
| 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 |
$16.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH PROINSULIN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84206
|
| Hospital Charge Code |
397072120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$72.60
|
| Rate for Payer: Aetna Medicare Advantage |
$86.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$96.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$96.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.69
|
| 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 |
$96.34
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$26.69
|
| Rate for Payer: Clover Medicare Advantage |
$25.36
|
| Rate for Payer: EmblemHealth Commercial |
$80.07
|
| Rate for Payer: Humana Medicare Advantage |
$27.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$26.69
|
| 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 |
$21.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH PROINSULIN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84206
|
| Hospital Charge Code |
397072120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH PROLACTIN
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
397071017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$176.50 |
| Rate for Payer: Aetna Commercial |
$52.71
|
| Rate for Payer: Aetna Medicare Advantage |
$62.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.38
|
| 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 |
$69.96
|
| Rate for Payer: Cigna Commercial |
$176.50
|
| Rate for Payer: Cigna Medicare Advantage |
$19.38
|
| Rate for Payer: Clover Medicare Advantage |
$18.41
|
| Rate for Payer: EmblemHealth Commercial |
$58.14
|
| Rate for Payer: Humana Medicare Advantage |
$19.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$105.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.35
|
|
|
CH PROLACTIN
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
397071017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.95 |
| Max. Negotiated Rate |
$52.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.95
|
|
|
CH PROLACTIN, TOTAL & FREE
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
397071494
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$52.71
|
| Rate for Payer: Aetna Medicare Advantage |
$62.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.38
|
| 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 |
$69.96
|
| Rate for Payer: Cigna Commercial |
$208.00
|
| Rate for Payer: Cigna Medicare Advantage |
$19.38
|
| Rate for Payer: Clover Medicare Advantage |
$18.41
|
| Rate for Payer: EmblemHealth Commercial |
$58.14
|
| Rate for Payer: Humana Medicare Advantage |
$19.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$124.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.02
|
|
