|
CH VOLUME MEASUREMENT
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 81050
|
| Hospital Charge Code |
397073578
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.00
|
|
|
CH VON WILLEBRAND ANTIGEN
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
397073318
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$32.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.70
|
|
|
CH VON WILLEBRAND ANTIGEN
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
397073318
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$62.40
|
| Rate for Payer: Aetna Medicare Advantage |
$74.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.94
|
| 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 |
$82.81
|
| Rate for Payer: Cigna Commercial |
$109.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.94
|
| Rate for Payer: Clover Medicare Advantage |
$21.79
|
| Rate for Payer: EmblemHealth Commercial |
$68.82
|
| Rate for Payer: Humana Medicare Advantage |
$23.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.78
|
|
|
CH VON WILLEBRAND MULTIMERS
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 85247
|
| Hospital Charge Code |
397073319
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$21.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.30
|
|
|
CH VON WILLEBRAND MULTIMERS
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 85247
|
| Hospital Charge Code |
397073319
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$62.40
|
| Rate for Payer: Aetna Medicare Advantage |
$74.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.81
|
| Rate for Payer: Cigna Commercial |
$71.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.94
|
| Rate for Payer: Clover Medicare Advantage |
$21.79
|
| Rate for Payer: EmblemHealth Commercial |
$68.82
|
| Rate for Payer: Humana Medicare Advantage |
$23.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.76
|
|
|
CH VON WILLEBRAND PROFILE
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
397072141
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.10
|
|
|
CH VON WILLEBRAND PROFILE
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
397072141
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: Aetna Medicare Advantage |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.61
|
| Rate for Payer: Cigna Commercial |
$247.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.90
|
| Rate for Payer: Clover Medicare Advantage |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$53.70
|
| Rate for Payer: Humana Medicare Advantage |
$18.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$148.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.09
|
|
|
CH VON WILLEBRAND RISTOCETIN
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
397073210
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
|
|
CH VON WILLEBRAND RISTOCETIN
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
397073210
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$62.40
|
| Rate for Payer: Aetna Medicare Advantage |
$74.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.94
|
| 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 |
$82.81
|
| Rate for Payer: Cigna Commercial |
$99.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.94
|
| Rate for Payer: Clover Medicare Advantage |
$21.79
|
| Rate for Payer: EmblemHealth Commercial |
$68.82
|
| Rate for Payer: Humana Medicare Advantage |
$23.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.25
|
|
|
CH VWF PROTEASE ACT W/RF INT
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS 85397
|
| Hospital Charge Code |
397071513
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$106.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$106.50
|
|
|
CH VWF PROTEASE ACT W/RF INT
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS 85397
|
| Hospital Charge Code |
397071513
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna Commercial |
$83.94
|
| Rate for Payer: Aetna Medicare Advantage |
$99.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$111.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$111.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$111.40
|
| Rate for Payer: Cigna Commercial |
$355.00
|
| Rate for Payer: Cigna Medicare Advantage |
$30.86
|
| Rate for Payer: Clover Medicare Advantage |
$29.32
|
| Rate for Payer: EmblemHealth Commercial |
$92.58
|
| Rate for Payer: Humana Medicare Advantage |
$31.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$30.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$213.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$106.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$30.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.82
|
|
|
CH WASHED RBC
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
397031049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$1,547.12 |
| Rate for Payer: Aetna Commercial |
$1,165.79
|
| Rate for Payer: Aetna Medicare Advantage |
$1,388.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,547.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,547.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$428.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,547.12
|
| Rate for Payer: Cigna Commercial |
$859.12
|
| Rate for Payer: Cigna Medicare Advantage |
$428.60
|
| Rate for Payer: Clover Medicare Advantage |
$407.17
|
| Rate for Payer: EmblemHealth Commercial |
$1,285.80
|
| Rate for Payer: Humana Medicare Advantage |
$441.46
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$428.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.20
|
| Rate for Payer: Oxford Commercial |
$666.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$428.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$428.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.02
|
|
|
CH WASHED RBC
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
397031049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$141.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.60
|
|
|
CH WBC COUNT
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS 8504891
|
| Hospital Charge Code |
397021289
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.55
|
|
|
CH WBC COUNT
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
397021022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.85
|
|
|
CH WBC COUNT
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
397021022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: Aetna Medicare Advantage |
$8.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.17
|
| Rate for Payer: Cigna Commercial |
$29.50
|
| Rate for Payer: Cigna Medicare Advantage |
$2.54
|
| Rate for Payer: Clover Medicare Advantage |
$2.41
|
| Rate for Payer: EmblemHealth Commercial |
$7.62
|
| Rate for Payer: Humana Medicare Advantage |
$2.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.56
|
|
|
CH WBC COUNT
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS 8504891
|
| Hospital Charge Code |
397021289
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: Aetna Medicare Advantage |
$5.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.33
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.45
|
|
|
CH WBC & DIFFERENTIAL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
397021061
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH WBC & DIFFERENTIAL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
397021061
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: Aetna Medicare Advantage |
$8.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.17
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$2.54
|
| Rate for Payer: Clover Medicare Advantage |
$2.41
|
| Rate for Payer: EmblemHealth Commercial |
$7.62
|
| Rate for Payer: Humana Medicare Advantage |
$2.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.54
|
| 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 |
$2.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH WELBUTRIM
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397071357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$43.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.80
|
|
|
CH WELBUTRIM
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
397071357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$146.00 |
| 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 |
$146.00
|
| 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 |
$87.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.80
|
| 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 |
$7.74
|
|
|
CH WESTNILE VIRUS IGG AB CSF
|
Facility
|
OP
|
$565.60
|
|
|
Service Code
|
HCPCS 86789
|
| Hospital Charge Code |
397040006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$282.80 |
| 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 |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.94
|
| Rate for Payer: Cigna Commercial |
$282.80
|
| 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 |
$169.68
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.84
|
| 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 |
$14.99
|
|
|
CH WESTNILE VIRUS IGG AB CSF
|
Facility
|
IP
|
$565.60
|
|
|
Service Code
|
HCPCS 86789
|
| Hospital Charge Code |
397040006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.84 |
| Max. Negotiated Rate |
$84.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.84
|
|
|
CH WESTNILE VIRUS IGM AB CSF
|
Facility
|
OP
|
$565.60
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
397040007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$282.80 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.82
|
| Rate for Payer: Cigna Commercial |
$282.80
|
| Rate for Payer: Cigna Medicare Advantage |
$16.85
|
| Rate for Payer: Clover Medicare Advantage |
$16.01
|
| Rate for Payer: EmblemHealth Commercial |
$50.55
|
| Rate for Payer: Humana Medicare Advantage |
$17.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.68
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.99
|
|
|
CH WESTNILE VIRUS IGM AB CSF
|
Facility
|
IP
|
$565.60
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
397040007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.84 |
| Max. Negotiated Rate |
$84.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.84
|
|
