|
CH PROTEIN S
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
397072122
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Aetna Commercial |
$31.58
|
| Rate for Payer: Aetna Medicare Advantage |
$37.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.91
|
| Rate for Payer: Cigna Commercial |
$169.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.61
|
| Rate for Payer: Clover Medicare Advantage |
$11.03
|
| Rate for Payer: EmblemHealth Commercial |
$34.83
|
| Rate for Payer: Humana Medicare Advantage |
$11.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.98
|
|
|
CH PROTEIN S
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
397072122
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.85 |
| Max. Negotiated Rate |
$50.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.85
|
|
|
CH PROTEIN S
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
397021299
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$67.35 |
| Max. Negotiated Rate |
$67.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.35
|
|
|
CH PROTEIN S
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
397021299
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$224.50 |
| Rate for Payer: Aetna Commercial |
$31.58
|
| Rate for Payer: Aetna Medicare Advantage |
$37.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.91
|
| Rate for Payer: Cigna Commercial |
$224.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.61
|
| Rate for Payer: Clover Medicare Advantage |
$11.03
|
| Rate for Payer: EmblemHealth Commercial |
$34.83
|
| Rate for Payer: Humana Medicare Advantage |
$11.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.90
|
|
|
CH PROTEIN S, ANTIGEN TOTAL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
397071446
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$31.58
|
| Rate for Payer: Aetna Medicare Advantage |
$37.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.91
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.61
|
| Rate for Payer: Clover Medicare Advantage |
$11.03
|
| Rate for Payer: EmblemHealth Commercial |
$34.83
|
| Rate for Payer: Humana Medicare Advantage |
$11.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.61
|
| 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 |
$9.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH PROTEIN S, ANTIGEN TOTAL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
397071446
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH PROTEIN SPINAL FLUID
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
397071310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$15,880.57 |
| Rate for Payer: Aetna Commercial |
$10.88
|
| Rate for Payer: Aetna Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.44
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: Cigna Medicare Advantage |
$4.00
|
| Rate for Payer: Clover Medicare Advantage |
$3.80
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Humana Medicare Advantage |
$4.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$15,880.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.35
|
|
|
CH PROTEIN SPINAL FLUID
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
397071310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.65
|
|
|
CH PROTEIN TOTAL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
397071036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.45
|
|
|
CH PROTEIN TOTAL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
397071036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$9.98
|
| Rate for Payer: Aetna Medicare Advantage |
$11.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.25
|
| Rate for Payer: Cigna Commercial |
$11.50
|
| Rate for Payer: Cigna Medicare Advantage |
$3.67
|
| Rate for Payer: Clover Medicare Advantage |
$3.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.01
|
| Rate for Payer: Humana Medicare Advantage |
$3.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.94
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.61
|
|
|
CH PROTHROMBIN TIME
|
Facility
|
OP
|
$317.94
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
397021012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$158.97 |
| Rate for Payer: Aetna Commercial |
$11.67
|
| Rate for Payer: Aetna Medicare Advantage |
$13.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.29
|
| 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 |
$15.49
|
| Rate for Payer: Cigna Commercial |
$158.97
|
| Rate for Payer: Cigna Medicare Advantage |
$4.29
|
| Rate for Payer: Clover Medicare Advantage |
$4.08
|
| Rate for Payer: EmblemHealth Commercial |
$12.87
|
| Rate for Payer: Humana Medicare Advantage |
$4.42
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$95.38
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.43
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.43
|
|
|
CH PROTHROMBIN TIME
|
Facility
|
IP
|
$317.94
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
397021012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.69 |
| Max. Negotiated Rate |
$47.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.69
|
|
|
CH PSA
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
397071165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$42.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.15
|
|
|
CH PSA
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
397071165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$140.50 |
| Rate for Payer: Aetna Commercial |
$50.02
|
| Rate for Payer: Aetna Medicare Advantage |
$59.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$47.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.38
|
| Rate for Payer: Cigna Commercial |
$140.50
|
| Rate for Payer: Cigna Medicare Advantage |
$18.39
|
| Rate for Payer: Clover Medicare Advantage |
$17.47
|
| Rate for Payer: EmblemHealth Commercial |
$55.17
|
| Rate for Payer: Humana Medicare Advantage |
$18.94
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.45
|
|
|
CH PSA, FREE
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
397073186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$50.02
|
| Rate for Payer: Aetna Medicare Advantage |
$59.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.38
|
| Rate for Payer: Cigna Commercial |
$261.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.39
|
| Rate for Payer: Clover Medicare Advantage |
$17.47
|
| Rate for Payer: EmblemHealth Commercial |
$55.17
|
| Rate for Payer: Humana Medicare Advantage |
$18.94
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.83
|
|
|
CH PSA, FREE
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
397073186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.30
|
|
|
CH PTH RELATED PEPTIDE
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397071020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$172.00 |
| 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 |
$172.00
|
| 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 |
$103.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.60
|
| 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 |
$9.12
|
|
|
CH PTH RELATED PEPTIDE
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397071020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.60
|
|
|
CH PT SUBSTITUTION
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
397021084
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$10.72
|
| Rate for Payer: Aetna Medicare Advantage |
$12.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.22
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.94
|
| Rate for Payer: Clover Medicare Advantage |
$3.74
|
| Rate for Payer: EmblemHealth Commercial |
$11.82
|
| Rate for Payer: Humana Medicare Advantage |
$4.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.94
|
| 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 |
$3.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH PT SUBSTITUTION
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
397021084
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH PTT
|
Facility
|
IP
|
$263.57
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
397021014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$39.54 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.54
|
|
|
CH PTT
|
Facility
|
OP
|
$263.57
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
397021014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$131.78 |
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Medicare Advantage |
$19.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.01
|
| 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 |
$21.69
|
| Rate for Payer: Cigna Commercial |
$131.78
|
| Rate for Payer: Cigna Medicare Advantage |
$6.01
|
| Rate for Payer: Clover Medicare Advantage |
$5.71
|
| Rate for Payer: EmblemHealth Commercial |
$18.03
|
| Rate for Payer: Humana Medicare Advantage |
$6.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$79.07
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.81
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.98
|
|
|
CH PTT SUBSTITUTION
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
397021085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Medicare Advantage |
$20.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.47
|
| 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 |
$23.35
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.47
|
| Rate for Payer: Clover Medicare Advantage |
$6.15
|
| Rate for Payer: EmblemHealth Commercial |
$19.41
|
| Rate for Payer: Humana Medicare Advantage |
$6.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.47
|
| 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 |
$5.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH PTT SUBSTITUTION
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
397021085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH PYRUVATE, BLOOD
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
HCPCS 84210
|
| Hospital Charge Code |
397070015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$74.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.55
|
|
