|
CH VALPROIC ACID
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
397071249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: Aetna Commercial |
$36.83
|
| Rate for Payer: Aetna Medicare Advantage |
$43.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.54
|
| 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 |
$48.88
|
| Rate for Payer: Cigna Commercial |
$142.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.54
|
| Rate for Payer: Clover Medicare Advantage |
$12.86
|
| Rate for Payer: EmblemHealth Commercial |
$40.62
|
| Rate for Payer: Humana Medicare Advantage |
$13.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.53
|
|
|
CH VALPROIC ACID
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
397071249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$42.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.60
|
|
|
CH VALPROIC ACID, FREE
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
397073351
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$35.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.55
|
|
|
CH VALPROIC ACID, FREE
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
397073351
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$36.83
|
| Rate for Payer: Aetna Medicare Advantage |
$43.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.54
|
| 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 |
$48.88
|
| Rate for Payer: Cigna Commercial |
$118.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.54
|
| Rate for Payer: Clover Medicare Advantage |
$12.86
|
| Rate for Payer: EmblemHealth Commercial |
$40.62
|
| Rate for Payer: Humana Medicare Advantage |
$13.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.28
|
|
|
CH VANCOMYCIN - PEAK
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
397073145
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
CH VANCOMYCIN - PEAK
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
397073145
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$36.83
|
| Rate for Payer: Aetna Medicare Advantage |
$43.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.54
|
| 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 |
$48.88
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.54
|
| Rate for Payer: Clover Medicare Advantage |
$12.86
|
| Rate for Payer: EmblemHealth Commercial |
$40.62
|
| Rate for Payer: Humana Medicare Advantage |
$13.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.08
|
|
|
CH VANCOMYCIN RANDOM
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
397073179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$36.83
|
| Rate for Payer: Aetna Medicare Advantage |
$43.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.54
|
| 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 |
$48.88
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.54
|
| Rate for Payer: Clover Medicare Advantage |
$12.86
|
| Rate for Payer: EmblemHealth Commercial |
$40.62
|
| Rate for Payer: Humana Medicare Advantage |
$13.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.08
|
|
|
CH VANCOMYCIN RANDOM
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
397073179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
CH VANCOMYCIN TROUGH
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
397071299
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
CH VANCOMYCIN TROUGH
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
397071299
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$36.83
|
| Rate for Payer: Aetna Medicare Advantage |
$43.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.54
|
| 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 |
$48.88
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.54
|
| Rate for Payer: Clover Medicare Advantage |
$12.86
|
| Rate for Payer: EmblemHealth Commercial |
$40.62
|
| Rate for Payer: Humana Medicare Advantage |
$13.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.08
|
|
|
CH VARICELLA-ZOSTER AB(IG)QN
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
397071419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$39.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| 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 |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.07
|
|
|
CH VARICELLA-ZOSTER AB(IG)QN
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
397071419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.70
|
|
|
CH VARICELLA ZOSTER DNA PCR
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
397073345
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$153.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$431.00
|
| Rate for Payer: Cigna Medicare Advantage |
$35.09
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$258.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.84
|
|
|
CH VARICELLA ZOSTER DNA PCR
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
397073345
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$129.30 |
| Max. Negotiated Rate |
$129.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.30
|
|
|
CH VARICELLA ZOSTER IGG
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
397041137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH VARICELLA ZOSTER IGG
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
397041137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| 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 |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH VENIPUNCTURE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
397073149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$25.40
|
| Rate for Payer: Aetna Medicare Advantage |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.71
|
| Rate for Payer: Cigna Commercial |
$32.00
|
| Rate for Payer: Cigna Medicare Advantage |
$9.34
|
| Rate for Payer: Clover Medicare Advantage |
$8.87
|
| Rate for Payer: EmblemHealth Commercial |
$28.02
|
| Rate for Payer: Humana Medicare Advantage |
$9.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.70
|
|
|
CH VENIPUNCTURE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
397073149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.60
|
|
|
CH VENOUS BLOOD GAS
|
Facility
|
IP
|
$1,255.57
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
397360005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.34 |
| Max. Negotiated Rate |
$188.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.34
|
|
|
CH VENOUS BLOOD GAS
|
Facility
|
OP
|
$1,255.57
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
397360005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$627.78 |
| Rate for Payer: Aetna Commercial |
$70.91
|
| Rate for Payer: Aetna Medicare Advantage |
$84.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$94.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$94.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| 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 |
$94.10
|
| Rate for Payer: Cigna Commercial |
$627.78
|
| Rate for Payer: Cigna Medicare Advantage |
$26.07
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$26.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$376.67
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.27
|
|
|
CH VERAPAMIL
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073150
|
|
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 VERAPAMIL
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397073150
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
|
|
CH VIP
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
397072020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH VIP
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
397072020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$96.10
|
| Rate for Payer: Aetna Medicare Advantage |
$114.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.53
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$35.33
|
| Rate for Payer: Clover Medicare Advantage |
$33.56
|
| Rate for Payer: EmblemHealth Commercial |
$105.99
|
| Rate for Payer: Humana Medicare Advantage |
$36.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.33
|
| 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 |
$28.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH VISCOSITY
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 85810
|
| Hospital Charge Code |
397071285
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.30
|
|
