|
CH VIT D, 1, 25 & 25 HYDROXY
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
397072136
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Aetna Medicare Advantage |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$138.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$138.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$138.97
|
| Rate for Payer: Cigna Commercial |
$1,025.00
|
| Rate for Payer: Cigna Medicare Advantage |
$38.50
|
| Rate for Payer: Clover Medicare Advantage |
$36.58
|
| Rate for Payer: EmblemHealth Commercial |
$115.50
|
| Rate for Payer: Humana Medicare Advantage |
$39.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$38.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$615.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$307.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$38.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$54.33
|
|
|
CH VIT D, 1, 25 & 25 HYDROXY
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
397072136
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$307.50 |
| Max. Negotiated Rate |
$307.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$307.50
|
|
|
CH VIT D 1,25DIHYDROXY
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
397073587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$67.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.95
|
|
|
CH VIT D 1,25DIHYDROXY
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
397073587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$226.50 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Aetna Medicare Advantage |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$138.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$138.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$138.97
|
| Rate for Payer: Cigna Commercial |
$226.50
|
| Rate for Payer: Cigna Medicare Advantage |
$38.50
|
| Rate for Payer: Clover Medicare Advantage |
$36.58
|
| Rate for Payer: EmblemHealth Commercial |
$115.50
|
| Rate for Payer: Humana Medicare Advantage |
$39.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$38.50
|
| 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 |
$30.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$38.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.00
|
|
|
CH VIT D, 1,25 DIHYDROXYL
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
397072137
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.45 |
| Max. Negotiated Rate |
$87.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.45
|
|
|
CH VIT D, 1,25 DIHYDROXYL
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
397072137
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.45 |
| Max. Negotiated Rate |
$291.50 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Aetna Medicare Advantage |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$138.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$138.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$138.97
|
| Rate for Payer: Cigna Commercial |
$291.50
|
| Rate for Payer: Cigna Medicare Advantage |
$38.50
|
| Rate for Payer: Clover Medicare Advantage |
$36.58
|
| Rate for Payer: EmblemHealth Commercial |
$115.50
|
| Rate for Payer: Humana Medicare Advantage |
$39.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$38.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$38.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.45
|
|
|
CH VIT D 25HYDROXY
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
397073586
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.50
|
|
|
CH VIT D 25HYDROXY
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
397073586
|
|
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 VIT D, 25 HYDROXY
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
397072138
|
|
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 VIT D, 25 HYDROXY
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
397072138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.50
|
|
|
CH VMA
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS 84585
|
| Hospital Charge Code |
397071031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$42.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.60
|
|
|
CH VMA
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS 84585
|
| Hospital Charge Code |
397071031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: Aetna Commercial |
$42.16
|
| Rate for Payer: Aetna Medicare Advantage |
$50.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.50
|
| 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 |
$55.95
|
| Rate for Payer: Cigna Commercial |
$142.00
|
| Rate for Payer: Cigna Medicare Advantage |
$15.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.72
|
| Rate for Payer: EmblemHealth Commercial |
$46.50
|
| Rate for Payer: Humana Medicare Advantage |
$15.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.50
|
| 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 |
$12.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.53
|
|
|
CH VMA URINE RANDOM
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
397073684
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.05
|
|
|
CH VMA URINE RANDOM
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
397073684
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$14.09
|
| Rate for Payer: Aetna Medicare Advantage |
$16.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.70
|
| Rate for Payer: Cigna Commercial |
$53.50
|
| Rate for Payer: Cigna Medicare Advantage |
$5.18
|
| Rate for Payer: Clover Medicare Advantage |
$4.92
|
| Rate for Payer: EmblemHealth Commercial |
$15.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.84
|
|
|
CH VOLATILES PLASMA
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
397072140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.54
|
| Rate for Payer: Aetna Medicare Advantage |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.11
|
| 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 |
$61.76
|
| Rate for Payer: Cigna Commercial |
$58.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.11
|
| Rate for Payer: Clover Medicare Advantage |
$16.25
|
| Rate for Payer: EmblemHealth Commercial |
$51.33
|
| Rate for Payer: Humana Medicare Advantage |
$17.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.07
|
|
|
CH VOLATILES PLASMA
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
397072140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.40
|
|
|
CH VOLATILE, URINE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
397073090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.40
|
|
|
CH VOLATILE, URINE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
397073090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.54
|
| Rate for Payer: Aetna Medicare Advantage |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.11
|
| 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 |
$61.76
|
| Rate for Payer: Cigna Commercial |
$58.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.11
|
| Rate for Payer: Clover Medicare Advantage |
$16.25
|
| Rate for Payer: EmblemHealth Commercial |
$51.33
|
| Rate for Payer: Humana Medicare Advantage |
$17.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.07
|
|
|
CH VOLTAGE GATED CALCIUM
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397073611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$441.00 |
| 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 |
$441.00
|
| 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 |
$264.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.30
|
| 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 |
$23.37
|
|
|
CH VOLTAGE GATED CALCIUM
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397073611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.30
|
|
|
CH VOLTGE GATED CALCIUM CHAB
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397073344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$210.00 |
| 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 |
$210.00
|
| 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 |
$126.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
| 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 |
$11.13
|
|
|
CH VOLTGE GATED CALCIUM CHAB
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397073344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
|
|
CH VOLUME MEAS FOR TIMED COL
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 81050
|
| Hospital Charge Code |
397073588
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Medicare Advantage |
$11.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.14
|
| Rate for Payer: Cigna Commercial |
$9.50
|
| Rate for Payer: Cigna Medicare Advantage |
$3.64
|
| Rate for Payer: Clover Medicare Advantage |
$3.46
|
| Rate for Payer: EmblemHealth Commercial |
$10.92
|
| Rate for Payer: Humana Medicare Advantage |
$3.75
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.50
|
|
|
CH VOLUME MEAS FOR TIMED COL
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 81050
|
| Hospital Charge Code |
397073588
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.85
|
|
|
CH VOLUME MEASUREMENT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 81050
|
| Hospital Charge Code |
397073578
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Medicare Advantage |
$11.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.14
|
| Rate for Payer: Cigna Commercial |
$10.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.64
|
| Rate for Payer: Clover Medicare Advantage |
$3.46
|
| Rate for Payer: EmblemHealth Commercial |
$10.92
|
| Rate for Payer: Humana Medicare Advantage |
$3.75
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.53
|
|
