|
CH T3, REVERSE
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 84482
|
| Hospital Charge Code |
397070003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.60
|
|
|
CH T3, REVERSE
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 84482
|
| Hospital Charge Code |
397070003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$42.87
|
| Rate for Payer: Aetna Medicare Advantage |
$51.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.89
|
| Rate for Payer: Cigna Commercial |
$22.00
|
| Rate for Payer: Cigna Medicare Advantage |
$15.76
|
| Rate for Payer: Clover Medicare Advantage |
$14.97
|
| Rate for Payer: EmblemHealth Commercial |
$47.28
|
| Rate for Payer: Humana Medicare Advantage |
$16.23
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
CH T3 TOTAL
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 84480
|
| Hospital Charge Code |
397071007
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.15
|
|
|
CH T3 TOTAL
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 84480
|
| Hospital Charge Code |
397071007
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$38.57
|
| Rate for Payer: Aetna Medicare Advantage |
$45.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.18
|
| 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 |
$51.19
|
| Rate for Payer: Cigna Commercial |
$80.50
|
| Rate for Payer: Cigna Medicare Advantage |
$14.18
|
| Rate for Payer: Clover Medicare Advantage |
$13.47
|
| Rate for Payer: EmblemHealth Commercial |
$42.54
|
| Rate for Payer: Humana Medicare Advantage |
$14.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.27
|
|
|
CH T3 UPTAKE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
397071313
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.35
|
| Rate for Payer: Cigna Commercial |
$56.50
|
| 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 |
$33.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.95
|
| 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 |
$2.99
|
|
|
CH T3 UPTAKE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
397071313
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$16.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.95
|
|
|
CH T4, FREE
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
397071318
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$226.50 |
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Medicare Advantage |
$29.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.56
|
| Rate for Payer: Cigna Commercial |
$226.50
|
| Rate for Payer: Cigna Medicare Advantage |
$9.02
|
| Rate for Payer: Clover Medicare Advantage |
$8.57
|
| Rate for Payer: EmblemHealth Commercial |
$27.06
|
| Rate for Payer: Humana Medicare Advantage |
$9.29
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.00
|
|
|
CH T4, FREE
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
397071318
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$67.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.95
|
|
|
CH T4, TOTAL
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
HCPCS 84436
|
| Hospital Charge Code |
397071159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$18.69
|
| Rate for Payer: Aetna Medicare Advantage |
$22.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.80
|
| Rate for Payer: Cigna Commercial |
$141.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.87
|
| Rate for Payer: Clover Medicare Advantage |
$6.53
|
| Rate for Payer: EmblemHealth Commercial |
$20.61
|
| Rate for Payer: Humana Medicare Advantage |
$7.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.47
|
|
|
CH T4, TOTAL
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
HCPCS 84436
|
| Hospital Charge Code |
397071159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.30
|
|
|
CH TACROLIMUS
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
397072153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.20
|
|
|
CH TACROLIMUS
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
397072153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$37.35
|
| Rate for Payer: Aetna Medicare Advantage |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.56
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.73
|
| Rate for Payer: Clover Medicare Advantage |
$13.04
|
| Rate for Payer: EmblemHealth Commercial |
$41.19
|
| Rate for Payer: Humana Medicare Advantage |
$14.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.51
|
|
|
CH TARTRATE RES ACP
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397073116
|
|
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 TARTRATE RES ACP
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397073116
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
|
|
CH T CELLS TOTAL
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 86359
|
| Hospital Charge Code |
397073306
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.70
|
|
|
CH T CELLS TOTAL
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 86359
|
| Hospital Charge Code |
397073306
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$136.19 |
| Rate for Payer: Aetna Commercial |
$102.63
|
| Rate for Payer: Aetna Medicare Advantage |
$122.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$136.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$136.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$136.19
|
| Rate for Payer: Cigna Commercial |
$39.00
|
| Rate for Payer: Cigna Medicare Advantage |
$37.73
|
| Rate for Payer: Clover Medicare Advantage |
$35.84
|
| Rate for Payer: EmblemHealth Commercial |
$113.19
|
| Rate for Payer: Humana Medicare Advantage |
$38.86
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$37.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$37.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.07
|
|
|
CH TERM DEOXYN TRANS
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 88346
|
| Hospital Charge Code |
397073160
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$14.07 |
| Max. Negotiated Rate |
$730.60 |
| Rate for Payer: Aetna Commercial |
$550.53
|
| Rate for Payer: Aetna Medicare Advantage |
$655.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$730.60
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$202.40
|
| Rate for Payer: Clover Medicare Advantage |
$192.28
|
| Rate for Payer: EmblemHealth Commercial |
$607.20
|
| Rate for Payer: Humana Medicare Advantage |
$208.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$202.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.07
|
|
|
CH TERM DEOXYN TRANS
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 88346
|
| Hospital Charge Code |
397073160
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$79.65 |
| Max. Negotiated Rate |
$79.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.65
|
|
|
CH TESTOSTERONE
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
397071320
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$43.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.95
|
|
|
CH TESTOSTERONE
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
397071320
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$146.50 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Medicare Advantage |
$83.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.17
|
| Rate for Payer: Cigna Commercial |
$146.50
|
| Rate for Payer: Cigna Medicare Advantage |
$25.81
|
| Rate for Payer: Clover Medicare Advantage |
$24.52
|
| Rate for Payer: EmblemHealth Commercial |
$77.43
|
| Rate for Payer: Humana Medicare Advantage |
$26.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$87.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.76
|
|
|
CH TESTOSTERONE FREE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 84402
|
| Hospital Charge Code |
397073302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
|
|
CH TESTOSTERONE FREE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 84402
|
| Hospital Charge Code |
397073302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$69.28
|
| Rate for Payer: Aetna Medicare Advantage |
$82.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$77.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.94
|
| Rate for Payer: Cigna Commercial |
$90.00
|
| Rate for Payer: Cigna Medicare Advantage |
$25.47
|
| Rate for Payer: Clover Medicare Advantage |
$24.20
|
| Rate for Payer: EmblemHealth Commercial |
$76.41
|
| Rate for Payer: Humana Medicare Advantage |
$26.23
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.77
|
|
|
CH THALLIUM BLOOD
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
397073678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$59.73
|
| Rate for Payer: Aetna Medicare Advantage |
$71.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.27
|
| Rate for Payer: Cigna Commercial |
$85.50
|
| Rate for Payer: Cigna Medicare Advantage |
$21.96
|
| Rate for Payer: Clover Medicare Advantage |
$20.86
|
| Rate for Payer: EmblemHealth Commercial |
$65.88
|
| Rate for Payer: Humana Medicare Advantage |
$22.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$51.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.57
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.53
|
|
|
CH THALLIUM BLOOD
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
397073678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.65
|
|
|
CH THC DAU
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 80300
|
| Hospital Charge Code |
397071293
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.60
|
|
