|
CH S PNEUMONIAE AG,LA
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
397071455
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$31.39
|
| Rate for Payer: Aetna Medicare Advantage |
$37.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.66
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.54
|
| Rate for Payer: Clover Medicare Advantage |
$10.96
|
| Rate for Payer: EmblemHealth Commercial |
$34.62
|
| Rate for Payer: Humana Medicare Advantage |
$11.89
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.40
|
|
|
CH S PNEUMONIAE AG,LA
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
397071455
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$24.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.90
|
|
|
CH S.PNEUMONIAE AG,LA
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
397073643
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$31.39
|
| Rate for Payer: Aetna Medicare Advantage |
$37.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.66
|
| Rate for Payer: Cigna Commercial |
$247.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.54
|
| Rate for Payer: Clover Medicare Advantage |
$10.96
|
| Rate for Payer: EmblemHealth Commercial |
$34.62
|
| Rate for Payer: Humana Medicare Advantage |
$11.89
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$148.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.09
|
|
|
CH S.PNEUMONIAE AG,LA
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
397073643
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.10
|
|
|
CH SQUAMOUS CELL CA
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
397072126
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.60
|
|
|
CH SQUAMOUS CELL CA
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
397072126
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.88 |
| 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 |
$92.00
|
| 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 |
$55.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.60
|
| 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 |
$4.88
|
|
|
CH SRP AUTOANTIBODIES
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
397071396
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.05
|
|
|
CH SRP AUTOANTIBODIES
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
397071396
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.55 |
| 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 |
$123.50
|
| 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 |
$74.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.05
|
| 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 |
$6.55
|
|
|
CH STAIN, AFB
|
Facility
|
OP
|
$526.40
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
397061058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$223.48 |
| Rate for Payer: Aetna Commercial |
$168.40
|
| Rate for Payer: Aetna Medicare Advantage |
$200.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$61.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.48
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: Cigna Medicare Advantage |
$61.91
|
| Rate for Payer: Clover Medicare Advantage |
$58.81
|
| Rate for Payer: EmblemHealth Commercial |
$185.73
|
| Rate for Payer: Humana Medicare Advantage |
$63.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$61.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$157.92
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$92.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.95
|
|
|
CH STAIN, AFB
|
Facility
|
IP
|
$526.40
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
397061058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.96 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.96
|
|
|
CH STAIN, FUNGUS
|
Facility
|
OP
|
$526.40
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
397061067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$223.48 |
| Rate for Payer: Aetna Commercial |
$168.40
|
| Rate for Payer: Aetna Medicare Advantage |
$200.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$61.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.48
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: Cigna Medicare Advantage |
$61.91
|
| Rate for Payer: Clover Medicare Advantage |
$58.81
|
| Rate for Payer: EmblemHealth Commercial |
$185.73
|
| Rate for Payer: Humana Medicare Advantage |
$63.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$61.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$157.92
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$92.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.95
|
|
|
CH STAIN, FUNGUS
|
Facility
|
IP
|
$526.40
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
397061067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.96 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.96
|
|
|
CH STAIN, GIEMSA
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061073
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$570.55 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.55
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.81
|
|
|
CH STAIN, GIEMSA
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061073
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
|
|
CH STAIN, GRAM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
397061062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH STAIN, GRAM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
397061062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$223.48 |
| Rate for Payer: Aetna Commercial |
$168.40
|
| Rate for Payer: Aetna Medicare Advantage |
$200.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$61.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.48
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: Cigna Medicare Advantage |
$61.91
|
| Rate for Payer: Clover Medicare Advantage |
$58.81
|
| Rate for Payer: EmblemHealth Commercial |
$185.73
|
| Rate for Payer: Humana Medicare Advantage |
$63.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$61.91
|
| 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 |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$92.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH STAIN, H & E
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
|
|
CH STAIN, H & E
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$570.55 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.55
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.81
|
|
|
CH STAIN, IRON
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
|
|
CH STAIN, IRON
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$570.55 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.55
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.81
|
|
|
CH STAIN, METHENAMINE SILVER
|
Facility
|
OP
|
$526.40
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
397061066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$223.48 |
| Rate for Payer: Aetna Commercial |
$168.40
|
| Rate for Payer: Aetna Medicare Advantage |
$200.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$61.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.48
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: Cigna Medicare Advantage |
$61.91
|
| Rate for Payer: Clover Medicare Advantage |
$58.81
|
| Rate for Payer: EmblemHealth Commercial |
$185.73
|
| Rate for Payer: Humana Medicare Advantage |
$63.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$61.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$157.92
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$92.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.95
|
|
|
CH STAIN, METHENAMINE SILVER
|
Facility
|
IP
|
$526.40
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
397061066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.96 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.96
|
|
|
CH STAIN, MUCICARMINE
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061064
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$570.55 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.55
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.81
|
|
|
CH STAIN, MUCICARMINE
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061064
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
|
|
CH STAIN PAS
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
397061367
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$223.48 |
| Rate for Payer: Aetna Commercial |
$168.40
|
| Rate for Payer: Aetna Medicare Advantage |
$200.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$61.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.48
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: Cigna Medicare Advantage |
$61.91
|
| Rate for Payer: Clover Medicare Advantage |
$58.81
|
| Rate for Payer: EmblemHealth Commercial |
$185.73
|
| Rate for Payer: Humana Medicare Advantage |
$63.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$61.91
|
| 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 |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$92.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
