|
CH BLOOD TRANSFUSION
|
Facility
|
IP
|
$1,403.75
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
397031003
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$210.56 |
| Max. Negotiated Rate |
$210.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.56
|
|
|
CH CA 15-3
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
397072002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare Advantage |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.49
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.81
|
| Rate for Payer: Clover Medicare Advantage |
$19.77
|
| Rate for Payer: EmblemHealth Commercial |
$62.43
|
| Rate for Payer: Humana Medicare Advantage |
$21.43
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH CA 15-3
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
397072002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH CALCIUM (RANDOM)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
397073110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH CALCIUM (RANDOM)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
397073110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna Medicare Advantage |
$16.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.72
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.16
|
| Rate for Payer: Clover Medicare Advantage |
$4.90
|
| Rate for Payer: EmblemHealth Commercial |
$15.48
|
| Rate for Payer: Humana Medicare Advantage |
$5.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
397071514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
397071514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$33.51
|
| Rate for Payer: Aetna Medicare Advantage |
$39.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.69
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.32
|
| Rate for Payer: Clover Medicare Advantage |
$11.70
|
| Rate for Payer: EmblemHealth Commercial |
$36.96
|
| Rate for Payer: Humana Medicare Advantage |
$12.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH CATHEPSIN D PARAFFI BLOCK 1
|
Facility
|
IP
|
$1,082.30
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
397061010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$162.34 |
| Max. Negotiated Rate |
$162.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.34
|
|
|
CH CATHEPSIN D PARAFFI BLOCK 1
|
Facility
|
OP
|
$1,082.30
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
397061010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$734.21 |
| Rate for Payer: Aetna Commercial |
$550.53
|
| Rate for Payer: Aetna Medicare Advantage |
$655.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$734.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$734.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$734.21
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$202.40
|
| Rate for Payer: Clover Medicare Advantage |
$192.28
|
| Rate for Payer: EmblemHealth Commercial |
$607.20
|
| Rate for Payer: Humana Medicare Advantage |
$208.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$202.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$281.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$86.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.74
|
|
|
CH C DIFFICILE TOXIN ASSAY
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 87230
|
| Hospital Charge Code |
397041304
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$53.69
|
| Rate for Payer: Aetna Medicare Advantage |
$63.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.61
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$19.74
|
| Rate for Payer: Clover Medicare Advantage |
$18.75
|
| Rate for Payer: EmblemHealth Commercial |
$59.22
|
| Rate for Payer: Humana Medicare Advantage |
$20.33
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.57
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
CH C DIFFICILE TOXIN ASSAY
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 87230
|
| Hospital Charge Code |
397041304
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH CEA ANTIGEN FLUID
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
397071075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$51.57
|
| Rate for Payer: Aetna Medicare Advantage |
$61.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.78
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.96
|
| Rate for Payer: Clover Medicare Advantage |
$18.01
|
| Rate for Payer: EmblemHealth Commercial |
$56.88
|
| Rate for Payer: Humana Medicare Advantage |
$19.53
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.17
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH CEA ANTIGEN FLUID
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
397071075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH CELL BLOCK
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
397061075
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$252.20 |
| Rate for Payer: Aetna Commercial |
$168.40
|
| Rate for Payer: Aetna Medicare Advantage |
$200.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$61.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$224.58
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: Cigna Medicare Advantage |
$61.91
|
| Rate for Payer: Clover Medicare Advantage |
$58.81
|
| Rate for Payer: EmblemHealth Commercial |
$185.73
|
| Rate for Payer: Humana Medicare Advantage |
$63.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$61.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$252.20
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$57.97
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.55
|
|
|
CH CELL BLOCK
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
397061075
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$145.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.50
|
|
|
CH CHROMOSOME ANALYSIS BLOOD
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
HCPCS 88261
|
| Hospital Charge Code |
397073007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$206.10 |
| Max. Negotiated Rate |
$206.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.10
|
|
|
CH CHROMOSOME ANALYSIS BLOOD
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
HCPCS 88261
|
| Hospital Charge Code |
397073007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$958.89 |
| Rate for Payer: Aetna Commercial |
$719.00
|
| Rate for Payer: Aetna Medicare Advantage |
$856.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$958.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$958.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$264.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$958.89
|
| Rate for Payer: Cigna Commercial |
$687.00
|
| Rate for Payer: Cigna Medicare Advantage |
$264.34
|
| Rate for Payer: Clover Medicare Advantage |
$251.12
|
| Rate for Payer: EmblemHealth Commercial |
$793.02
|
| Rate for Payer: Humana Medicare Advantage |
$272.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$264.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$357.24
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$43.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$264.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$264.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.02
|
|
|
CH CHROMOSOME - BONE MARROW
|
Facility
|
IP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
397072152
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$407.10 |
| Max. Negotiated Rate |
$407.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$407.10
|
|
|
CH CHROMOSOME - BONE MARROW
|
Facility
|
OP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
397072152
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$77.08 |
| Max. Negotiated Rate |
$1,357.00 |
| Rate for Payer: Aetna Commercial |
$391.00
|
| Rate for Payer: Aetna Medicare Advantage |
$465.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$521.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$521.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$143.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$521.45
|
| Rate for Payer: Cigna Commercial |
$1,357.00
|
| Rate for Payer: Cigna Medicare Advantage |
$143.75
|
| Rate for Payer: Clover Medicare Advantage |
$136.56
|
| Rate for Payer: EmblemHealth Commercial |
$431.25
|
| Rate for Payer: Humana Medicare Advantage |
$148.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$143.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$705.64
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$407.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$115.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$143.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$143.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$77.08
|
|
|
CH CKMB
|
Facility
|
OP
|
$807.65
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
397071108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$403.82 |
| Rate for Payer: Aetna Commercial |
$31.42
|
| Rate for Payer: Aetna Medicare Advantage |
$37.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.90
|
| Rate for Payer: Cigna Commercial |
$403.82
|
| Rate for Payer: Cigna Medicare Advantage |
$11.55
|
| Rate for Payer: Clover Medicare Advantage |
$10.97
|
| Rate for Payer: EmblemHealth Commercial |
$34.65
|
| Rate for Payer: Humana Medicare Advantage |
$11.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$209.99
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$121.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.94
|
|
|
CH CKMB
|
Facility
|
IP
|
$807.65
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
397071108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$121.15 |
| Max. Negotiated Rate |
$121.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$121.15
|
|
|
CH CMV IGM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
397043225
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.12
|
| 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 |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.12
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| 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 |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| 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 |
$11.08
|
|
|
CH CMV IGM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
397043225
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH COMPL C1 ESTERASE INIT
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397072049
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$32.64
|
| Rate for Payer: Aetna Medicare Advantage |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.53
|
| Rate for Payer: Cigna Commercial |
$86.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.00
|
| Rate for Payer: Clover Medicare Advantage |
$11.40
|
| Rate for Payer: EmblemHealth Commercial |
$36.00
|
| Rate for Payer: Humana Medicare Advantage |
$12.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.98
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.91
|
|
|
CH COMPL C1 ESTERASE INIT
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
397072049
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
