|
CH PYRUVATE, BLOOD
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
HCPCS 84210
|
| Hospital Charge Code |
397070015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$248.50 |
| Rate for Payer: Aetna Commercial |
$39.39
|
| Rate for Payer: Aetna Medicare Advantage |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.48
|
| 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 |
$52.27
|
| Rate for Payer: Cigna Commercial |
$248.50
|
| Rate for Payer: Cigna Medicare Advantage |
$14.48
|
| Rate for Payer: Clover Medicare Advantage |
$13.76
|
| Rate for Payer: EmblemHealth Commercial |
$43.44
|
| Rate for Payer: Humana Medicare Advantage |
$14.91
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$149.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.17
|
|
|
CH PYRUVIC ACID
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
HCPCS 84210
|
| Hospital Charge Code |
397070012
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$39.39
|
| Rate for Payer: Aetna Medicare Advantage |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.48
|
| 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 |
$52.27
|
| Rate for Payer: Cigna Commercial |
$220.50
|
| Rate for Payer: Cigna Medicare Advantage |
$14.48
|
| Rate for Payer: Clover Medicare Advantage |
$13.76
|
| Rate for Payer: EmblemHealth Commercial |
$43.44
|
| Rate for Payer: Humana Medicare Advantage |
$14.91
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$132.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.69
|
|
|
CH PYRUVIC ACID
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
HCPCS 84210
|
| Hospital Charge Code |
397070012
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.15
|
|
|
CH QUINIDINE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 80194
|
| Hospital Charge Code |
397071015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.50
|
|
|
CH QUINIDINE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 80194
|
| Hospital Charge Code |
397071015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$39.71
|
| Rate for Payer: Aetna Medicare Advantage |
$47.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.60
|
| 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 |
$52.70
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.60
|
| Rate for Payer: Clover Medicare Advantage |
$13.87
|
| Rate for Payer: EmblemHealth Commercial |
$43.80
|
| Rate for Payer: Humana Medicare Advantage |
$15.04
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$51.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.50
|
|
|
CH RAPAMYCIN
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397071083
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.65 |
| Max. Negotiated Rate |
$49.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.65
|
|
|
CH RAPAMYCIN
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397071083
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$165.50 |
| 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 |
$165.50
|
| 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 |
$99.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.65
|
| 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 |
$8.77
|
|
|
CH RA, SERUM
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86430
|
| Hospital Charge Code |
397041082
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH RA, SERUM
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86430
|
| Hospital Charge Code |
397041082
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: Aetna Medicare Advantage |
$19.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.14
|
| 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 |
$22.16
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$6.14
|
| Rate for Payer: Clover Medicare Advantage |
$5.83
|
| Rate for Payer: EmblemHealth Commercial |
$18.42
|
| Rate for Payer: Humana Medicare Advantage |
$6.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.28
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
CH RAST ANTIGEN, EA
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397073617
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.95
|
|
|
CH RAST ANTIGEN, EA
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397072147
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.05 |
| 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 |
$76.50
|
| 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 |
$45.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.95
|
| 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 |
$4.05
|
|
|
CH RAST ANTIGEN, EA
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397073617
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.05 |
| 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 |
$76.50
|
| 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 |
$45.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.95
|
| 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 |
$4.05
|
|
|
CH RAST ANTIGEN, EA
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397072147
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.95
|
|
|
CH RAST REGIONAL PANEL
|
Facility
|
IP
|
$752.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397072148
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.80
|
|
|
CH RAST REGIONAL PANEL
|
Facility
|
OP
|
$752.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
397072148
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$376.00 |
| 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 |
$376.00
|
| 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 |
$225.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.80
|
| 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 |
$19.93
|
|
|
CH RBC AUTOLOGOUS
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
397031032
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$476.24
|
| Rate for Payer: Aetna Medicare Advantage |
$567.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$632.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$632.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$175.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$632.02
|
| Rate for Payer: Cigna Commercial |
$350.96
|
| Rate for Payer: Cigna Medicare Advantage |
$175.09
|
| Rate for Payer: Clover Medicare Advantage |
$166.34
|
| Rate for Payer: EmblemHealth Commercial |
$525.27
|
| Rate for Payer: Humana Medicare Advantage |
$180.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$175.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.00
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$175.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.73
|
|
|
CH RBC AUTOLOGOUS
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
397031032
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.00
|
|
|
CH RBC CMV NEG LEUKORED
|
Facility
|
IP
|
$990.90
|
|
|
Service Code
|
HCPCS P9051
|
| Hospital Charge Code |
397031167
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$148.63 |
| Max. Negotiated Rate |
$148.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$148.63
|
|
|
CH RBC CMV NEG LEUKORED
|
Facility
|
OP
|
$990.90
|
|
|
Service Code
|
HCPCS P9051
|
| Hospital Charge Code |
397031167
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$479.43
|
| Rate for Payer: Aetna Medicare Advantage |
$571.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$636.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$636.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$176.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$636.25
|
| Rate for Payer: Cigna Commercial |
$353.31
|
| Rate for Payer: Cigna Medicare Advantage |
$176.26
|
| Rate for Payer: Clover Medicare Advantage |
$167.45
|
| Rate for Payer: EmblemHealth Commercial |
$528.78
|
| Rate for Payer: Humana Medicare Advantage |
$181.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$176.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$297.27
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$148.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$176.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$176.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.26
|
|
|
CH RBC COUNT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 85041
|
| Hospital Charge Code |
397021076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.40
|
|
|
CH RBC COUNT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 85041
|
| Hospital Charge Code |
397021076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$8.21
|
| Rate for Payer: Aetna Medicare Advantage |
$9.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.90
|
| Rate for Payer: Cigna Commercial |
$38.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.02
|
| Rate for Payer: Clover Medicare Advantage |
$2.87
|
| Rate for Payer: EmblemHealth Commercial |
$9.06
|
| Rate for Payer: Humana Medicare Advantage |
$3.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.01
|
|
|
CH RBC DEGLYCEROLIZED
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
HCPCS P9054
|
| Hospital Charge Code |
397031050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$838.77
|
| Rate for Payer: Aetna Medicare Advantage |
$999.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,113.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,113.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$308.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,113.12
|
| Rate for Payer: Cigna Commercial |
$618.15
|
| Rate for Payer: Cigna Medicare Advantage |
$308.37
|
| Rate for Payer: Clover Medicare Advantage |
$292.95
|
| Rate for Payer: EmblemHealth Commercial |
$925.11
|
| Rate for Payer: Humana Medicare Advantage |
$317.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$308.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$531.30
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$265.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$308.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$308.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.93
|
|
|
CH RBC DEGLYCEROLIZED
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
HCPCS P9054
|
| Hospital Charge Code |
397031050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$265.65 |
| Max. Negotiated Rate |
$265.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$265.65
|
|
|
CH RBC DEGLY LEUKO IRRAD
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
HCPCS P9057
|
| Hospital Charge Code |
397031172
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$296.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
CH RBC DEGLY LEUKO IRRAD
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
HCPCS P9057
|
| Hospital Charge Code |
397031172
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$1,774.24 |
| Rate for Payer: Aetna Commercial |
$1,336.93
|
| Rate for Payer: Aetna Medicare Advantage |
$1,592.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,774.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,774.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$491.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,774.24
|
| Rate for Payer: Cigna Commercial |
$985.26
|
| Rate for Payer: Cigna Medicare Advantage |
$491.52
|
| Rate for Payer: Clover Medicare Advantage |
$466.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,474.56
|
| Rate for Payer: Humana Medicare Advantage |
$506.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$491.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$592.50
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$491.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$491.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.34
|
|
