|
CH TOPIRAMATE (TOPAMAX)
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 80201
|
| Hospital Charge Code |
397073555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Medicare Advantage |
$38.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.03
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.92
|
| Rate for Payer: Clover Medicare Advantage |
$11.32
|
| Rate for Payer: EmblemHealth Commercial |
$35.76
|
| Rate for Payer: Humana Medicare Advantage |
$12.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.54
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.15
|
|
|
CH TOTAL AMYLASE
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
397073257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$17.63
|
| Rate for Payer: Aetna Medicare Advantage |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.48
|
| 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 |
$23.39
|
| Rate for Payer: Cigna Commercial |
$57.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.48
|
| Rate for Payer: Clover Medicare Advantage |
$6.16
|
| Rate for Payer: EmblemHealth Commercial |
$19.44
|
| Rate for Payer: Humana Medicare Advantage |
$6.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.48
|
| 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 |
$5.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.02
|
|
|
CH TOTAL AMYLASE
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
397073257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.10
|
|
|
CH TOTAL CK
|
Facility
|
IP
|
$385.26
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
397073254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.79 |
| Max. Negotiated Rate |
$57.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.79
|
|
|
CH TOTAL CK
|
Facility
|
OP
|
$385.26
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
397073254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$192.63 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.50
|
| Rate for Payer: Cigna Commercial |
$192.63
|
| Rate for Payer: Cigna Medicare Advantage |
$6.51
|
| Rate for Payer: Clover Medicare Advantage |
$6.18
|
| Rate for Payer: EmblemHealth Commercial |
$19.53
|
| Rate for Payer: Humana Medicare Advantage |
$6.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$115.58
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.21
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.21
|
|
|
CH TOTAL LIPIDS, FL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
397073054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH TOTAL LIPIDS, FL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
397073054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: Aetna Medicare Advantage |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.24
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.10
|
| Rate for Payer: Clover Medicare Advantage |
$7.70
|
| Rate for Payer: EmblemHealth Commercial |
$24.30
|
| Rate for Payer: Humana Medicare Advantage |
$8.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.10
|
| 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 |
$6.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH TOTAL PROTEIN (RANDOM)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
397073114
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH TOTAL PROTEIN (RANDOM)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
397073114
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$195.00
|
| 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 |
$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 |
$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 |
$10.34
|
|
|
CH TOXOPLASMA GONDII IGM CSF
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
397071540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.90
|
|
|
CH TOXOPLASMA GONDII IGM CSF
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
397071540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$39.20
|
| Rate for Payer: Aetna Medicare Advantage |
$46.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.41
|
| 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 |
$52.02
|
| Rate for Payer: Cigna Commercial |
$43.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.41
|
| Rate for Payer: Clover Medicare Advantage |
$13.69
|
| Rate for Payer: EmblemHealth Commercial |
$43.23
|
| Rate for Payer: Humana Medicare Advantage |
$14.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.53
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.28
|
|
|
CH TOXOPLASMA IGG/IGM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
397043215
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare Advantage |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.94
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.39
|
| Rate for Payer: Clover Medicare Advantage |
$13.67
|
| Rate for Payer: EmblemHealth Commercial |
$43.17
|
| Rate for Payer: Humana Medicare Advantage |
$14.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.39
|
| 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 |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH TOXOPLASMA IGG/IGM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
397043215
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH TRAMADOL-SERUM
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 80373
|
| Hospital Charge Code |
397071476
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.50
|
|
|
CH TRAMADOL-SERUM
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 80373
|
| Hospital Charge Code |
397071476
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna Commercial |
$163.40
|
| Rate for Payer: Aetna Medicare Advantage |
$129.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.65
|
| Rate for Payer: Cigna Commercial |
$215.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.39
|
|
|
CH TRANSFERRIN
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 84466
|
| Hospital Charge Code |
397071211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$24.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.60
|
|
|
CH TRANSFERRIN
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS 84466
|
| Hospital Charge Code |
397071211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$34.71
|
| Rate for Payer: Aetna Medicare Advantage |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.06
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.76
|
| Rate for Payer: Clover Medicare Advantage |
$12.12
|
| Rate for Payer: EmblemHealth Commercial |
$38.28
|
| Rate for Payer: Humana Medicare Advantage |
$13.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.21
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.35
|
|
|
CH TRANSGLUTAMINASE ANTIBODY
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397073596
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$40.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.15
|
|
|
CH TRANSGLUTAMINASE ANTIBODY
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
397073596
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.15
|
|
|
CH TRAZODONE
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397072131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| 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 |
$42.50
|
| 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 |
$25.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
| 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 |
$2.25
|
|
|
CH TRAZODONE
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397072131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
|
|
CH TRH (SPEC TUBE REQUIRED)
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397073658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$450.00 |
| 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 |
$450.00
|
| 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 |
$270.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
| 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 |
$23.85
|
|
|
CH TRH (SPEC TUBE REQUIRED)
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397073658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
CH TRIAVIL
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
397072132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Aetna Commercial |
$96.52
|
| Rate for Payer: Aetna Medicare Advantage |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.77
|
| Rate for Payer: Cigna Commercial |
$127.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.73
|
|
|
CH TRIAVIL
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
397072132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$38.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.10
|
|
