|
CH PROTEIN ELECTROPHOR
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
397071161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$34.80
|
| Rate for Payer: Aetna Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.35
|
| Rate for Payer: Cigna Commercial |
$10.74
|
| Rate for Payer: Cigna Medicare Advantage |
$5.37
|
| Rate for Payer: Clover Medicare Advantage |
$10.20
|
| Rate for Payer: EmblemHealth Commercial |
$32.22
|
| Rate for Payer: Humana Medicare Advantage |
$11.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$11.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.74
|
|
|
CH PROTEIN ELECTROPHOR
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
397071161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.50
|
|
|
CH PROTEIN ELECTROPHOR CSF
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
397071375
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$16.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.95
|
|
|
CH PROTEIN ELECTROPHOR CSF
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
397071375
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$57.77
|
| Rate for Payer: Aetna Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.33
|
| Rate for Payer: Cigna Commercial |
$17.83
|
| Rate for Payer: Cigna Medicare Advantage |
$8.91
|
| Rate for Payer: Clover Medicare Advantage |
$16.94
|
| Rate for Payer: EmblemHealth Commercial |
$53.49
|
| Rate for Payer: Humana Medicare Advantage |
$18.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.69
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.83
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$18.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.83
|
|
|
CH PROTEIN S
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
397021299
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$37.62
|
| Rate for Payer: Aetna Medicare Advantage |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.54
|
| 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 |
$29.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.54
|
| Rate for Payer: Cigna Commercial |
$11.61
|
| Rate for Payer: Cigna Medicare Advantage |
$5.80
|
| 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: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.37
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.61
|
|
|
CH PROTEIN S
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
397021299
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$67.35 |
| Max. Negotiated Rate |
$67.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.35
|
|
|
CH PROTEIN S
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
397072122
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.85 |
| Max. Negotiated Rate |
$50.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.85
|
|
|
CH PROTEIN S
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
397072122
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$37.62
|
| Rate for Payer: Aetna Medicare Advantage |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.54
|
| 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 |
$29.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.54
|
| Rate for Payer: Cigna Commercial |
$11.61
|
| Rate for Payer: Cigna Medicare Advantage |
$5.80
|
| 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: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.07
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.61
|
|
|
CH PROTEIN S, ANTIGEN TOTAL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
397071446
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH PROTEIN S, ANTIGEN TOTAL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
397071446
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$37.62
|
| Rate for Payer: Aetna Medicare Advantage |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.54
|
| 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 |
$29.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.54
|
| Rate for Payer: Cigna Commercial |
$11.61
|
| Rate for Payer: Cigna Medicare Advantage |
$5.80
|
| 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: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.61
|
|
|
CH PROTEIN SPINAL FLUID
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
397071310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.65
|
|
|
CH PROTEIN SPINAL FLUID
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
397071310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$15,880.57 |
| Rate for Payer: Aetna Better Health Medicaid |
$15,569.19
|
| Rate for Payer: Aetna Commercial |
$12.96
|
| Rate for Payer: Aetna Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.66
|
| Rate for Payer: Cigna Commercial |
$4.00
|
| Rate for Payer: Cigna Medicare Advantage |
$2.00
|
| Rate for Payer: Clover Medicare Advantage |
$3.80
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Humana Medicare Advantage |
$4.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.63
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.00
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$4.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$15,880.57
|
|
|
CH PROTEIN TOTAL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
397071036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.45
|
|
|
CH PROTEIN TOTAL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
397071036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$11.89
|
| Rate for Payer: Aetna Medicare Advantage |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.45
|
| Rate for Payer: Cigna Commercial |
$3.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1.83
|
| Rate for Payer: Clover Medicare Advantage |
$3.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.01
|
| Rate for Payer: Humana Medicare Advantage |
$3.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.99
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$3.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.67
|
|
|
CH PROTHROMBIN TIME
|
Facility
|
IP
|
$317.94
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
397021012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.69 |
| Max. Negotiated Rate |
$47.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.69
|
|
|
CH PROTHROMBIN TIME
|
Facility
|
OP
|
$317.94
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
397021012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna Medicare Advantage |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.72
|
| Rate for Payer: Cigna Commercial |
$4.29
|
| Rate for Payer: Cigna Medicare Advantage |
$2.15
|
| Rate for Payer: Clover Medicare Advantage |
$4.08
|
| Rate for Payer: EmblemHealth Commercial |
$12.87
|
| Rate for Payer: Humana Medicare Advantage |
$4.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.33
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.29
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$4.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.29
|
|
|
CH PSA
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
397071165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$59.58
|
| Rate for Payer: Aetna Medicare Advantage |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.38
|
| Rate for Payer: Cigna Commercial |
$18.39
|
| Rate for Payer: Cigna Medicare Advantage |
$9.20
|
| Rate for Payer: Clover Medicare Advantage |
$17.47
|
| Rate for Payer: EmblemHealth Commercial |
$55.17
|
| Rate for Payer: Humana Medicare Advantage |
$18.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.53
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.39
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$19.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.39
|
|
|
CH PSA
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
397071165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$42.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.15
|
|
|
CH PSA, FREE
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
397073186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.30
|
|
|
CH PSA, FREE
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
397073186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$59.58
|
| Rate for Payer: Aetna Medicare Advantage |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.38
|
| Rate for Payer: Cigna Commercial |
$18.39
|
| Rate for Payer: Cigna Medicare Advantage |
$9.20
|
| Rate for Payer: Clover Medicare Advantage |
$17.47
|
| Rate for Payer: EmblemHealth Commercial |
$55.17
|
| Rate for Payer: Humana Medicare Advantage |
$18.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.86
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.39
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$19.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.39
|
|
|
CH PTH RELATED PEPTIDE
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397071020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.60
|
|
|
CH PTH RELATED PEPTIDE
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
397071020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$59.62
|
| Rate for Payer: Aetna Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.42
|
| 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 |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.42
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Cigna Medicare Advantage |
$9.20
|
| 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: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.72
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$19.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
|
|
CH PT SUBSTITUTION
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
397021084
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$12.77
|
| Rate for Payer: Aetna Medicare Advantage |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.44
|
| Rate for Payer: Cigna Commercial |
$3.94
|
| Rate for Payer: Cigna Medicare Advantage |
$1.97
|
| Rate for Payer: Clover Medicare Advantage |
$3.74
|
| Rate for Payer: EmblemHealth Commercial |
$11.82
|
| Rate for Payer: Humana Medicare Advantage |
$4.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.94
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$4.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.94
|
|
|
CH PT SUBSTITUTION
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
397021084
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH PTT
|
Facility
|
IP
|
$263.57
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
397021014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$39.54 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.54
|
|
