|
CH VISCOSITY
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 85810
|
| Hospital Charge Code |
397071285
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$31.74
|
| Rate for Payer: Aetna Medicare Advantage |
$37.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.67
|
| 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 |
$42.13
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.67
|
| Rate for Payer: Clover Medicare Advantage |
$11.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.01
|
| Rate for Payer: Humana Medicare Advantage |
$12.02
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.70
|
|
|
CH VITAMIN A
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
397071185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$31.58
|
| Rate for Payer: Aetna Medicare Advantage |
$37.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.61
|
| 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 |
$41.91
|
| Rate for Payer: Cigna Commercial |
$79.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.61
|
| Rate for Payer: Clover Medicare Advantage |
$11.03
|
| Rate for Payer: EmblemHealth Commercial |
$34.83
|
| Rate for Payer: Humana Medicare Advantage |
$11.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.19
|
|
|
CH VITAMIN A
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
397071185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$23.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.70
|
|
|
CH VITAMIN B1
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
397071251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Aetna Medicare Advantage |
$68.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.23
|
| 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 |
$76.63
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: Cigna Medicare Advantage |
$21.23
|
| Rate for Payer: Clover Medicare Advantage |
$20.17
|
| Rate for Payer: EmblemHealth Commercial |
$63.69
|
| Rate for Payer: Humana Medicare Advantage |
$21.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.96
|
|
|
CH VITAMIN B1
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
397071251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
CH VITAMIN B12
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
397071270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$41.02
|
| Rate for Payer: Aetna Medicare Advantage |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.08
|
| 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 |
$54.43
|
| Rate for Payer: Cigna Commercial |
$46.50
|
| Rate for Payer: Cigna Medicare Advantage |
$15.08
|
| Rate for Payer: Clover Medicare Advantage |
$14.33
|
| Rate for Payer: EmblemHealth Commercial |
$45.24
|
| Rate for Payer: Humana Medicare Advantage |
$15.53
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.46
|
|
|
CH VITAMIN B12
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
397071270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.95
|
|
|
CH VITAMIN B-2
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
397073014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$55.05
|
| Rate for Payer: Aetna Medicare Advantage |
$65.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$73.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$73.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$63.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$73.06
|
| Rate for Payer: Cigna Commercial |
$103.50
|
| Rate for Payer: Cigna Medicare Advantage |
$20.24
|
| Rate for Payer: Clover Medicare Advantage |
$19.23
|
| Rate for Payer: EmblemHealth Commercial |
$60.72
|
| Rate for Payer: Humana Medicare Advantage |
$20.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.49
|
|
|
CH VITAMIN B-2
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
397073014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
|
|
CH VITAMIN B-6
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
397073015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$24,078.00 |
| Rate for Payer: Aetna Commercial |
$76.43
|
| Rate for Payer: Aetna Medicare Advantage |
$91.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$101.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$101.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$28.10
|
| 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 |
$101.43
|
| Rate for Payer: Cigna Commercial |
$223.00
|
| Rate for Payer: Cigna Medicare Advantage |
$28.10
|
| Rate for Payer: Clover Medicare Advantage |
$26.70
|
| Rate for Payer: EmblemHealth Commercial |
$84.30
|
| Rate for Payer: Humana Medicare Advantage |
$28.94
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$28.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$28.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.10
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$24,078.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.82
|
|
|
CH VITAMIN B-6
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
397073015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.90 |
| Max. Negotiated Rate |
$66.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.90
|
|
|
CH VITAMIN B7 (BIOTIN)
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 84591
|
| Hospital Charge Code |
397071393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Commercial |
$46.40
|
| Rate for Payer: Aetna Medicare Advantage |
$55.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.58
|
| Rate for Payer: Cigna Commercial |
$214.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.06
|
| Rate for Payer: Clover Medicare Advantage |
$16.21
|
| Rate for Payer: EmblemHealth Commercial |
$51.18
|
| Rate for Payer: Humana Medicare Advantage |
$17.57
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.37
|
|
|
CH VITAMIN B7 (BIOTIN)
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 84591
|
| Hospital Charge Code |
397071393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.35
|
|
|
CH VITAMIN C
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
397073016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
CH VITAMIN C
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
397073016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$26.90
|
| Rate for Payer: Aetna Medicare Advantage |
$32.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35.70
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: Cigna Medicare Advantage |
$9.89
|
| Rate for Payer: Clover Medicare Advantage |
$9.40
|
| Rate for Payer: EmblemHealth Commercial |
$29.67
|
| Rate for Payer: Humana Medicare Advantage |
$10.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
|
CH VITAMIN D
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
394014001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$30.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.30
|
|
|
CH VITAMIN D
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
394014001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$80.51
|
| Rate for Payer: Aetna Medicare Advantage |
$95.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$106.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$106.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$106.85
|
| Rate for Payer: Cigna Commercial |
$101.00
|
| Rate for Payer: Cigna Medicare Advantage |
$29.60
|
| Rate for Payer: Clover Medicare Advantage |
$28.12
|
| Rate for Payer: EmblemHealth Commercial |
$88.80
|
| Rate for Payer: Humana Medicare Advantage |
$30.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$29.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.35
|
|
|
CH VITAMIN D3
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
397071346
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna Commercial |
$80.51
|
| Rate for Payer: Aetna Medicare Advantage |
$95.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$106.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$106.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$106.85
|
| Rate for Payer: Cigna Commercial |
$235.00
|
| Rate for Payer: Cigna Medicare Advantage |
$29.60
|
| Rate for Payer: Clover Medicare Advantage |
$28.12
|
| Rate for Payer: EmblemHealth Commercial |
$88.80
|
| Rate for Payer: Humana Medicare Advantage |
$30.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$29.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$141.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.46
|
|
|
CH VITAMIN D3
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
397071346
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.50
|
|
|
CH VITAMIN E
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 84446
|
| Hospital Charge Code |
397073589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.20
|
|
|
CH VITAMIN E
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 84446
|
| Hospital Charge Code |
397073589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.33 |
| 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 |
$40.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.19
|
| Rate for Payer: Cigna Commercial |
$44.00
|
| 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 |
$26.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.20
|
| 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 |
$2.33
|
|
|
CH VITAMIN K
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 84597
|
| Hospital Charge Code |
397071109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$165.50 |
| Rate for Payer: Aetna Commercial |
$37.32
|
| Rate for Payer: Aetna Medicare Advantage |
$44.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.53
|
| Rate for Payer: Cigna Commercial |
$165.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.72
|
| Rate for Payer: Clover Medicare Advantage |
$13.03
|
| Rate for Payer: EmblemHealth Commercial |
$41.16
|
| Rate for Payer: Humana Medicare Advantage |
$14.13
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.72
|
| 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 |
$10.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.77
|
|
|
CH VITAMIN K
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 84597
|
| Hospital Charge Code |
397071109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.65 |
| Max. Negotiated Rate |
$49.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.65
|
|
|
CH VIT B-12 BINDING CAPACITY
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS 82608
|
| Hospital Charge Code |
397072139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$134.00 |
| Rate for Payer: Aetna Commercial |
$38.95
|
| Rate for Payer: Aetna Medicare Advantage |
$46.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.32
|
| 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 |
$51.69
|
| Rate for Payer: Cigna Commercial |
$134.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.32
|
| Rate for Payer: Clover Medicare Advantage |
$13.60
|
| Rate for Payer: EmblemHealth Commercial |
$42.96
|
| Rate for Payer: Humana Medicare Advantage |
$14.75
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.46
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.10
|
|
|
CH VIT B-12 BINDING CAPACITY
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS 82608
|
| Hospital Charge Code |
397072139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$40.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.20
|
|
