|
CPK ISOENZYMES
|
Facility
|
IP
|
$136.85
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
3003258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$20.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.53
|
|
|
CPK ROCHE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
3030079
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$21.09
|
| Rate for Payer: Aetna Medicare Advantage |
$6.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.85
|
| Rate for Payer: Cigna Commercial |
$6.51
|
| Rate for Payer: Cigna Medicare Advantage |
$3.25
|
| Rate for Payer: Clover Medicare Advantage |
$6.18
|
| Rate for Payer: EmblemHealth Commercial |
$19.53
|
| Rate for Payer: Humana Medicare Advantage |
$6.71
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.58
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.51
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$6.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.51
|
|
|
CPK ROCHE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
3030079
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
|
|
CPM MOTION RENTAL
|
Facility
|
IP
|
$156.85
|
|
| Hospital Charge Code |
270607645
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$23.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.53
|
|
|
CPM MOTION RENTAL
|
Facility
|
OP
|
$156.85
|
|
| Hospital Charge Code |
270607645
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$78.42 |
| Rate for Payer: Aetna Commercial |
$47.05
|
| Rate for Payer: Aetna Medicare Advantage |
$47.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.00
|
| Rate for Payer: Cigna Commercial |
$78.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.39
|
| Rate for Payer: Oxford Commercial |
$78.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$78.42
|
|
|
CPM PADDING PATIENT
|
Facility
|
OP
|
$445.00
|
|
| Hospital Charge Code |
270647739
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$57.85 |
| Max. Negotiated Rate |
$222.50 |
| Rate for Payer: Aetna Commercial |
$133.50
|
| Rate for Payer: Aetna Medicare Advantage |
$133.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$113.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$113.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$113.47
|
| Rate for Payer: Cigna Commercial |
$222.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.85
|
| Rate for Payer: Oxford Commercial |
$222.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$222.50
|
|
|
CPM PADDING PATIENT
|
Facility
|
IP
|
$445.00
|
|
| Hospital Charge Code |
270647739
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.75
|
|
|
CPM RENTAL
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
270608965
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.50
|
|
|
CPM RENTAL
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
270608965
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Medicare Advantage |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.25
|
| Rate for Payer: Cigna Commercial |
$75.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.50
|
| Rate for Payer: Oxford Commercial |
$75.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$75.00
|
|
|
CPM RENTAL****
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
612866
|
|
Hospital Revenue Code
|
299
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Aetna Medicare Advantage |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.01
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.65
|
|
|
CPM RENTAL****
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
612866
|
|
Hospital Revenue Code
|
299
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.65
|
|
|
CPM RENTAL CUSTOM
|
Facility
|
IP
|
$133.65
|
|
|
Service Code
|
HCPCS E0935
|
| Hospital Charge Code |
270612974
|
|
Hospital Revenue Code
|
291
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.05
|
|
|
CPM RENTAL CUSTOM
|
Facility
|
OP
|
$133.65
|
|
|
Service Code
|
HCPCS E0935
|
| Hospital Charge Code |
270612974
|
|
Hospital Revenue Code
|
291
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$66.83 |
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Medicare Advantage |
$40.09
|
| 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) PPO |
$34.08
|
| Rate for Payer: Cigna Commercial |
$66.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.05
|
|
|
CPM RENTAL CUSTOM****
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS E0935
|
| Hospital Charge Code |
270612866
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.55
|
|
|
CPM RENTAL CUSTOM****
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS E0935
|
| Hospital Charge Code |
270612866
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Medicare Advantage |
$17.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.54
|
| Rate for Payer: Cigna Commercial |
$28.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.41
|
| Rate for Payer: Oxford Commercial |
$28.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.50
|
|
|
CPM SOFT GOODS
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
270633426
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
|
|
CPM SOFT GOODS
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
270633426
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Aetna Commercial |
$34.50
|
| Rate for Payer: Aetna Medicare Advantage |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.32
|
| Rate for Payer: Cigna Commercial |
$57.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.95
|
| Rate for Payer: Oxford Commercial |
$57.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$57.50
|
|
|
CPM SOFTGOODS
|
Facility
|
IP
|
$95.00
|
|
| Hospital Charge Code |
270624513
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.25
|
|
|
CPM SOFTGOODS
|
Facility
|
OP
|
$95.00
|
|
| Hospital Charge Code |
270624513
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Medicare Advantage |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.23
|
| Rate for Payer: Cigna Commercial |
$47.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.35
|
| Rate for Payer: Oxford Commercial |
$47.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$47.50
|
|
|
C PNEU IGA
|
Facility
|
IP
|
$153.65
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
3000941C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.05
|
|
|
C PNEU IGA
|
Facility
|
OP
|
$153.65
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
3000941C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$41.08
|
| Rate for Payer: Aetna Medicare Advantage |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.46
|
| Rate for Payer: Cigna Commercial |
$12.68
|
| Rate for Payer: Cigna Medicare Advantage |
$6.34
|
| Rate for Payer: Clover Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$38.04
|
| Rate for Payer: Humana Medicare Advantage |
$13.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.97
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.68
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$13.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.68
|
|
|
C PNEU IGG
|
Facility
|
IP
|
$153.65
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
3000941B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.05
|
|
|
C PNEU IGG
|
Facility
|
OP
|
$153.65
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
3000941B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$41.08
|
| Rate for Payer: Aetna Medicare Advantage |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.46
|
| Rate for Payer: Cigna Commercial |
$12.68
|
| Rate for Payer: Cigna Medicare Advantage |
$6.34
|
| Rate for Payer: Clover Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$38.04
|
| Rate for Payer: Humana Medicare Advantage |
$13.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.97
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.68
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$13.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.68
|
|
|
C PNEU IGM
|
Facility
|
OP
|
$153.65
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
3000941A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$41.08
|
| Rate for Payer: Aetna Medicare Advantage |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.46
|
| Rate for Payer: Cigna Commercial |
$12.68
|
| Rate for Payer: Cigna Medicare Advantage |
$6.34
|
| Rate for Payer: Clover Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$38.04
|
| Rate for Payer: Humana Medicare Advantage |
$13.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.97
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.68
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$13.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.68
|
|
|
C PNEU IGM
|
Facility
|
IP
|
$153.65
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
3000941A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.05
|
|