|
CHLAMYDIA PANEL VII
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
39990141G
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$34.49
|
| Rate for Payer: Aetna Medicare Advantage |
$41.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.00
|
| 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 |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.00
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$12.68
|
| 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: Longevity Health Plan of New Jersey Medicare Advantage |
$12.68
|
| 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 |
$10.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
CHLAMYDIA PANEL VIII
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
39990141H
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CHLAMYDIA PANEL VIII
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
39990141H
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$34.49
|
| Rate for Payer: Aetna Medicare Advantage |
$41.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.00
|
| 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 |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.00
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$12.68
|
| 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: Longevity Health Plan of New Jersey Medicare Advantage |
$12.68
|
| 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 |
$10.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
CHLAMYDIA QUANT
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 87492
|
| Hospital Charge Code |
38478110
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$193.96 |
| Rate for Payer: Aetna Commercial |
$145.44
|
| Rate for Payer: Aetna Medicare Advantage |
$173.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$193.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$193.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$53.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$32.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$193.96
|
| Rate for Payer: Cigna Commercial |
$123.00
|
| Rate for Payer: Cigna Medicare Advantage |
$53.47
|
| Rate for Payer: Clover Medicare Advantage |
$50.80
|
| Rate for Payer: EmblemHealth Commercial |
$160.41
|
| Rate for Payer: Humana Medicare Advantage |
$55.07
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$53.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.96
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$53.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.99
|
|
|
CHLAMYDIA QUANT
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 87492
|
| Hospital Charge Code |
38478110
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.90
|
|
|
CHLAMYDIA THROAT APTIMA
|
Facility
|
OP
|
$175.45
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
401087491
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$32.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.29
|
| Rate for Payer: Cigna Commercial |
$87.72
|
| Rate for Payer: Cigna Medicare Advantage |
$35.09
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.62
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.98
|
|
|
CHLAMYDIA THROAT APTIMA
|
Facility
|
IP
|
$175.45
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
401087491
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$26.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.32
|
|
|
CHLAMYDIA TRACHOMITIS
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
39708053B
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$32.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.29
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$35.09
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.09
|
| 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 |
$28.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CHLAMYDIA TRACHOMITIS
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
39708053B
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH LEUKOCYTE ALK PHOS
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85540
|
| Hospital Charge Code |
397021050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$23.39
|
| Rate for Payer: Aetna Medicare Advantage |
$27.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.20
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.60
|
| Rate for Payer: Clover Medicare Advantage |
$8.17
|
| Rate for Payer: EmblemHealth Commercial |
$25.80
|
| Rate for Payer: Humana Medicare Advantage |
$8.86
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.60
|
| 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 |
$6.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH LEUKOCYTE ALK PHOS
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85540
|
| Hospital Charge Code |
397021050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH LEUKOCYTES FECAL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 89055
|
| Hospital Charge Code |
397071121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$11.61
|
| Rate for Payer: Aetna Medicare Advantage |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.49
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.27
|
| Rate for Payer: Clover Medicare Advantage |
$4.06
|
| Rate for Payer: EmblemHealth Commercial |
$12.81
|
| Rate for Payer: Humana Medicare Advantage |
$4.40
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.27
|
| 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 |
$3.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH LEUKOCYTES FECAL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 89055
|
| Hospital Charge Code |
397071121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH LEVEL 1 - GROSS ONLY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 88300
|
| Hospital Charge Code |
397061000
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH LEVEL 1 - GROSS ONLY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 88300
|
| Hospital Charge Code |
397061000
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$93.46
|
| Rate for Payer: Aetna Medicare Advantage |
$111.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$34.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.64
|
| Rate for Payer: Cigna Commercial |
$68.87
|
| Rate for Payer: Cigna Medicare Advantage |
$34.36
|
| Rate for Payer: Clover Medicare Advantage |
$32.64
|
| Rate for Payer: EmblemHealth Commercial |
$103.08
|
| Rate for Payer: Humana Medicare Advantage |
$35.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$34.36
|
| 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 |
$13.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$34.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH LEVEL 2 - GROSS & MICRO
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
HCPCS 88302
|
| Hospital Charge Code |
397061364
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.70
|
|
|
CH LEVEL 2 - GROSS & MICRO
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
HCPCS 88302
|
| Hospital Charge Code |
397061364
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$160.95 |
| Rate for Payer: Aetna Commercial |
$120.69
|
| Rate for Payer: Aetna Medicare Advantage |
$143.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.95
|
| Rate for Payer: Cigna Commercial |
$88.94
|
| Rate for Payer: Cigna Medicare Advantage |
$44.37
|
| Rate for Payer: Clover Medicare Advantage |
$42.15
|
| Rate for Payer: EmblemHealth Commercial |
$133.11
|
| Rate for Payer: Humana Medicare Advantage |
$45.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$44.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.68
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$44.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.87
|
|
|
CH LEVEL 3 - GROSS & MICRO
|
Facility
|
OP
|
$873.60
|
|
|
Service Code
|
HCPCS 88304
|
| Hospital Charge Code |
397061021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.81 |
| Max. Negotiated Rate |
$227.14 |
| 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 |
$227.14
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.81
|
|
|
CH LEVEL 3 - GROSS & MICRO
|
Facility
|
IP
|
$873.60
|
|
|
Service Code
|
HCPCS 88304
|
| Hospital Charge Code |
397061021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$131.04 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.04
|
|
|
CH LEVEL 3-GROSS & MICRO-ADD
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
HCPCS 8830491
|
| Hospital Charge Code |
397061085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$237.12
|
| Rate for Payer: Aetna Medicare Advantage |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$159.12
|
| Rate for Payer: Cigna Commercial |
$312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.24
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.72
|
|
|
CH LEVEL 3-GROSS & MICRO-ADD
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
HCPCS 8830491
|
| Hospital Charge Code |
397061085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.60
|
|
|
CH LEVEL 4 - GROSS & MICRO
|
Facility
|
OP
|
$1,358.00
|
|
|
Service Code
|
HCPCS 88305TC
|
| Hospital Charge Code |
397061074
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$679.00 |
| Rate for Payer: Aetna Commercial |
$516.04
|
| Rate for Payer: Aetna Medicare Advantage |
$407.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$346.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$346.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$346.29
|
| Rate for Payer: Cigna Commercial |
$679.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$353.08
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.57
|
|
|
CH LEVEL 4 - GROSS & MICRO
|
Facility
|
IP
|
$1,358.00
|
|
|
Service Code
|
HCPCS 88305TC
|
| Hospital Charge Code |
397061074
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$203.70 |
| Max. Negotiated Rate |
$203.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$203.70
|
|
|
CH LEVEL 4-GROSS & MICRO-ADD
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 8830591
|
| Hospital Charge Code |
397061086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Aetna Commercial |
$368.60
|
| Rate for Payer: Aetna Medicare Advantage |
$291.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$247.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$247.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$247.35
|
| Rate for Payer: Cigna Commercial |
$485.00
|
| 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 |
$30.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.55
|
|
|
CH LEVEL 4-GROSS & MICRO-ADD
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 8830591
|
| Hospital Charge Code |
397061086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$145.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.50
|
|
