|
CHEST W/ CONTRAST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
2200087
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CHEST W/ CONTRAST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
2200087
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$145.87 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$281.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$755.90
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,470.00
|
| Rate for Payer: Oxford Commercial |
$3,774.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,916.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$300.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.80
|
|
|
CHEST W/O CONTRAST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
2200103
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CHEST W/O CONTRAST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
2200103
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$240.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$86.94
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,470.00
|
| Rate for Payer: Oxford Commercial |
$3,774.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,916.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$300.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.80
|
|
|
CHEST W/O & HIGH RES CHEST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
2200104
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CHEST W/O & HIGH RES CHEST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
2200104
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$240.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$86.94
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,470.00
|
| Rate for Payer: Oxford Commercial |
$3,774.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,916.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$300.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.80
|
|
|
CHEST W/WO CONTRAST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
2200095
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$145.87 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$755.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$288.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$755.90
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,470.00
|
| Rate for Payer: Oxford Commercial |
$3,774.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,916.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$300.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.80
|
|
|
CHEST W/WO CONTRAST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
2200095
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CH FACTOR X
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
397071188
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH FACTOR X
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
397071188
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$64.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.93
|
| 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 |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.93
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| 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 |
$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 |
$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 |
$11.08
|
|
|
CH FFP X1
|
Facility
|
OP
|
$352.35
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
397031006
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$271.95
|
| Rate for Payer: Aetna Medicare Advantage |
$323.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$362.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$362.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$99.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$362.68
|
| Rate for Payer: Cigna Commercial |
$200.40
|
| Rate for Payer: Cigna Medicare Advantage |
$99.98
|
| Rate for Payer: Clover Medicare Advantage |
$94.98
|
| Rate for Payer: EmblemHealth Commercial |
$299.94
|
| Rate for Payer: Humana Medicare Advantage |
$102.98
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$99.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$91.61
|
| Rate for Payer: Oxford Commercial |
$1,028.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$99.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.01
|
|
|
CH FFP X1
|
Facility
|
IP
|
$352.35
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
397031006
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$52.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.85
|
|
|
CH FIBRIN DEG PROD
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85362
|
| Hospital Charge Code |
397021006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH FIBRIN DEG PROD
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85362
|
| Hospital Charge Code |
397021006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: Aetna Medicare Advantage |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.89
|
| 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 |
$24.99
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.89
|
| Rate for Payer: Clover Medicare Advantage |
$6.55
|
| Rate for Payer: EmblemHealth Commercial |
$20.67
|
| Rate for Payer: Humana Medicare Advantage |
$7.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.89
|
| 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 |
$5.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH FOLLICLE STIMULAT HORMONE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83001
|
| Hospital Charge Code |
397071180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH FOLLICLE STIMULAT HORMONE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83001
|
| Hospital Charge Code |
397071180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Medicare Advantage |
$60.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.58
|
| 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 |
$67.40
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.58
|
| Rate for Payer: Clover Medicare Advantage |
$17.65
|
| Rate for Payer: EmblemHealth Commercial |
$55.74
|
| Rate for Payer: Humana Medicare Advantage |
$19.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.58
|
| 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 |
$14.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH FREE KAPPA LAMBDA RAND UR
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
397071509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
|
|
CH FREE KAPPA LAMBDA RAND UR
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
397071509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$36.99
|
| Rate for Payer: Aetna Medicare Advantage |
$44.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$146.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.33
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.60
|
| Rate for Payer: Clover Medicare Advantage |
$12.92
|
| Rate for Payer: EmblemHealth Commercial |
$40.80
|
| Rate for Payer: Humana Medicare Advantage |
$14.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$176.80
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.31
|
|
|
CH FREE T3
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
397073592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$46.08
|
| Rate for Payer: Aetna Medicare Advantage |
$54.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.45
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$16.94
|
| Rate for Payer: Clover Medicare Advantage |
$16.09
|
| Rate for Payer: EmblemHealth Commercial |
$50.82
|
| Rate for Payer: Humana Medicare Advantage |
$17.45
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.94
|
| 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 |
$13.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
CH FREE T3
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
397073592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH GENTAMICIN - PEAK
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
397073144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH GENTAMICIN - PEAK
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
397073144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Aetna Medicare Advantage |
$53.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.42
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.38
|
| Rate for Payer: Clover Medicare Advantage |
$15.56
|
| Rate for Payer: EmblemHealth Commercial |
$49.14
|
| Rate for Payer: Humana Medicare Advantage |
$16.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.38
|
| 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 |
$13.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH GENTAMYCIN RANDOM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
397073181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Aetna Medicare Advantage |
$53.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.42
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.38
|
| Rate for Payer: Clover Medicare Advantage |
$15.56
|
| Rate for Payer: EmblemHealth Commercial |
$49.14
|
| Rate for Payer: Humana Medicare Advantage |
$16.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.38
|
| 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 |
$13.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH GENTAMYCIN RANDOM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
397073181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH GENTAMYCIN THROUGH
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
397071316
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Aetna Medicare Advantage |
$53.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.42
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.38
|
| Rate for Payer: Clover Medicare Advantage |
$15.56
|
| Rate for Payer: EmblemHealth Commercial |
$49.14
|
| Rate for Payer: Humana Medicare Advantage |
$16.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.38
|
| 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 |
$13.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
