|
CELEXA 10MG TAB
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60635428
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
CELEXA 40 MG TAB U/D
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
60635289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.80
|
|
|
CELEXA 40 MG TAB U/D
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
60635289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare Advantage |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.06
|
| Rate for Payer: Cigna Commercial |
$6.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.56
|
| Rate for Payer: Oxford Commercial |
$6.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.00
|
|
|
CELIAC DISEASE COMP PANEL I
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
39990072A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CELIAC DISEASE COMP PANEL I
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
39990072A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$37.36
|
| Rate for Payer: Aetna Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.25
|
| Rate for Payer: Cigna Commercial |
$11.53
|
| Rate for Payer: Cigna Medicare Advantage |
$5.76
|
| Rate for Payer: Clover Medicare Advantage |
$10.95
|
| Rate for Payer: EmblemHealth Commercial |
$34.59
|
| Rate for Payer: Humana Medicare Advantage |
$11.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$86.79
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.53
|
|
|
CELIAC DISEASE COMP PANEL II
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
39990072B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CELIAC DISEASE COMP PANEL II
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
39990072B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$30.13
|
| Rate for Payer: Aetna Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.08
|
| Rate for Payer: Cigna Commercial |
$9.30
|
| Rate for Payer: Cigna Medicare Advantage |
$4.65
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$86.79
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$9.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
|
|
CELIAC DS INDIR IMMUNOFL ASSAY
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 88346
|
| Hospital Charge Code |
3035162
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.80
|
|
|
CELIAC DS INDIR IMMUNOFL ASSAY
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 88346
|
| Hospital Charge Code |
3035162
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$405.73 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Medicare Advantage |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.66
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$78.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.16
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
CELIAC DS QUANT IMMUNOASS 2/TI
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3035160B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$149.70 |
| Rate for Payer: Aetna Commercial |
$55.95
|
| Rate for Payer: Aetna Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.28
|
| 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 |
$13.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.28
|
| Rate for Payer: Cigna Commercial |
$17.27
|
| Rate for Payer: Cigna Medicare Advantage |
$8.63
|
| 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: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.74
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$18.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
|
|
CELIAC DS QUANT IMMUNOASS 2/TI
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3035160C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$149.70 |
| Max. Negotiated Rate |
$149.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.70
|
|
|
CELIAC DS QUANT IMMUNOASS 2/TI
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3035160A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$149.70 |
| Rate for Payer: Aetna Commercial |
$55.95
|
| Rate for Payer: Aetna Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.28
|
| 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 |
$13.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.28
|
| Rate for Payer: Cigna Commercial |
$17.27
|
| Rate for Payer: Cigna Medicare Advantage |
$8.63
|
| 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: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.74
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$18.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
|
|
CELIAC DS QUANT IMMUNOASS 2/TI
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3035160A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$149.70 |
| Max. Negotiated Rate |
$149.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.70
|
|
|
CELIAC DS QUANT IMMUNOASS 2/TI
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3035160B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$149.70 |
| Max. Negotiated Rate |
$149.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.70
|
|
|
CELIAC DS QUANT IMMUNOASS 2/TI
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3035160C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$149.70 |
| Rate for Payer: Aetna Commercial |
$55.95
|
| Rate for Payer: Aetna Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.28
|
| 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 |
$13.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.28
|
| Rate for Payer: Cigna Commercial |
$17.27
|
| Rate for Payer: Cigna Medicare Advantage |
$8.63
|
| 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: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.74
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$18.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
|
|
CELIAC GEN INTERPR AND REPORT
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS 83912
|
| Hospital Charge Code |
3035167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
|
|
CELIAC GEN INTERPR AND REPORT
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS 83912
|
| Hospital Charge Code |
3035167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.78
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.91
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
CELIAC PLEXUS BLOC (ANALGESIC)
|
Facility
|
IP
|
$3,107.20
|
|
|
Service Code
|
HCPCS 64530
|
| Hospital Charge Code |
84506050
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$466.08 |
| Max. Negotiated Rate |
$466.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$466.08
|
|
|
CELIAC PLEXUS BLOC (ANALGESIC)
|
Facility
|
OP
|
$3,107.20
|
|
|
Service Code
|
HCPCS 64530
|
| Hospital Charge Code |
84506050
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$403.94 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$932.16
|
| Rate for Payer: Aetna Medicare Advantage |
$932.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$792.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$792.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$792.34
|
| Rate for Payer: Cigna Commercial |
$2,106.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$403.94
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$466.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
CELIAC PLUS
|
Facility
|
IP
|
$799.00
|
|
| Hospital Charge Code |
3035160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$119.85
|
|
|
CELIAC PLUS
|
Facility
|
OP
|
$799.00
|
|
| Hospital Charge Code |
3035160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna Medicare Advantage |
$239.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$203.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$203.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$203.75
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$103.87
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$119.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
CELL ASSURITY PACEMAKER
|
Facility
|
OP
|
$32,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270676936
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,800.00 |
| Max. Negotiated Rate |
$16,000.00 |
| Rate for Payer: Aetna Commercial |
$9,600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,160.00
|
| Rate for Payer: Cigna Commercial |
$16,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,744.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,800.00
|
|
|
CELL ASSURITY PACEMAKER
|
Facility
|
IP
|
$32,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270676936
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,800.00 |
| Max. Negotiated Rate |
$7,744.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,744.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,800.00
|
|
|
CELLCEPT 500MG TAB
|
Facility
|
OP
|
$114.84
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
60635225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$34.45 |
| Rate for Payer: Aetna Commercial |
$34.45
|
| Rate for Payer: Aetna Medicare Advantage |
$34.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.28
|
| Rate for Payer: Cigna Commercial |
$0.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.23
|
|
|
CELLCEPT 500MG TAB
|
Facility
|
IP
|
$114.84
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
60635225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$27.79 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.23
|
|
