|
CH PHOSPHATIDYSERINE (G,A,M)
|
Facility
|
IP
|
$1,248.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
397071415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.20
|
|
|
CH PHOSPHATIDYSERINE (G,A,M)
|
Facility
|
OP
|
$1,248.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
397071415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$43.71
|
| Rate for Payer: Aetna Medicare Advantage |
$52.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.29
|
| Rate for Payer: Cigna Commercial |
$624.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.07
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$324.48
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.44
|
|
|
CH PHOSPHORUS URINE 24 HR
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84105
|
| Hospital Charge Code |
397071311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare Advantage |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.78
|
| 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 |
$20.97
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.78
|
| Rate for Payer: Clover Medicare Advantage |
$5.49
|
| Rate for Payer: EmblemHealth Commercial |
$17.34
|
| Rate for Payer: Humana Medicare Advantage |
$5.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.78
|
| 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 |
$4.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH PHOSPHORUS URINE 24 HR
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84105
|
| Hospital Charge Code |
397071311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH PLATELET FUNCTION TEST
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
397021096
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH PLATELET FUNCTION TEST
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
397021096
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Aetna Medicare Advantage |
$80.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$90.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$90.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$90.36
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.91
|
| Rate for Payer: Clover Medicare Advantage |
$23.66
|
| Rate for Payer: EmblemHealth Commercial |
$74.73
|
| Rate for Payer: Humana Medicare Advantage |
$25.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.91
|
| 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 |
$19.93
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH PLATELETS PHERESIS LEUKO
|
Facility
|
OP
|
$5,626.57
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
397031163
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$159.79 |
| Max. Negotiated Rate |
$2,158.00 |
| Rate for Payer: Aetna Commercial |
$1,618.13
|
| Rate for Payer: Aetna Medicare Advantage |
$1,927.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,158.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,158.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$594.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,158.00
|
| Rate for Payer: Cigna Commercial |
$1,192.48
|
| Rate for Payer: Cigna Medicare Advantage |
$594.90
|
| Rate for Payer: Clover Medicare Advantage |
$565.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,784.70
|
| Rate for Payer: Humana Medicare Advantage |
$612.75
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$594.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,462.91
|
| Rate for Payer: Oxford Commercial |
$1,028.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$843.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$177.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$594.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$594.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$159.79
|
|
|
CH PLATELETS PHERESIS LEUKO
|
Facility
|
IP
|
$5,626.57
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
397031163
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$843.99 |
| Max. Negotiated Rate |
$843.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$843.99
|
|
|
CH PORPHOBILINOGEN QUANT
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
397071253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$22.96
|
| Rate for Payer: Aetna Medicare Advantage |
$27.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.62
|
| Rate for Payer: Cigna Commercial |
$30.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.44
|
| Rate for Payer: Clover Medicare Advantage |
$8.02
|
| Rate for Payer: EmblemHealth Commercial |
$25.32
|
| Rate for Payer: Humana Medicare Advantage |
$8.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.60
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.70
|
|
|
CH PORPHOBILINOGEN QUANT
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
397071253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
|
|
CH PROCALCITONIN SERUM
|
Facility
|
IP
|
$1,249.59
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
397073679
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$187.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.44
|
|
|
CH PROCALCITONIN SERUM
|
Facility
|
OP
|
$1,249.59
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
397073679
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.78 |
| Max. Negotiated Rate |
$624.79 |
| Rate for Payer: Aetna Commercial |
$74.04
|
| Rate for Payer: Aetna Medicare Advantage |
$88.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$98.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$98.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$27.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$98.74
|
| Rate for Payer: Cigna Commercial |
$624.79
|
| Rate for Payer: Cigna Medicare Advantage |
$27.22
|
| Rate for Payer: Clover Medicare Advantage |
$25.86
|
| Rate for Payer: EmblemHealth Commercial |
$81.66
|
| Rate for Payer: Humana Medicare Advantage |
$28.04
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$27.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$324.89
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$27.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.49
|
|
|
CH PROGESTERONE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
397071019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$56.74
|
| Rate for Payer: Aetna Medicare Advantage |
$67.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.67
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.86
|
| Rate for Payer: Clover Medicare Advantage |
$19.82
|
| Rate for Payer: EmblemHealth Commercial |
$62.58
|
| Rate for Payer: Humana Medicare Advantage |
$21.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.86
|
| 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 |
$16.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH PROGESTERONE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
397071019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH PROINSULIN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84206
|
| Hospital Charge Code |
397072120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$72.60
|
| Rate for Payer: Aetna Medicare Advantage |
$86.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$96.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$96.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$96.82
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$26.69
|
| Rate for Payer: Clover Medicare Advantage |
$25.36
|
| Rate for Payer: EmblemHealth Commercial |
$80.07
|
| Rate for Payer: Humana Medicare Advantage |
$27.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$26.69
|
| 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 |
$21.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH PROINSULIN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84206
|
| Hospital Charge Code |
397072120
|
|
Hospital Revenue Code
|
301
|
| 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 |
$9.29 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$31.58
|
| Rate for Payer: Aetna Medicare Advantage |
$37.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.12
|
| 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 |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.12
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.61
|
| 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: Longevity Health Plan of New Jersey Medicare Advantage |
$11.61
|
| 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 |
$9.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
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 PT SUBSTITUTION
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
397021084
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$10.72
|
| Rate for Payer: Aetna Medicare Advantage |
$12.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.29
|
| 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 |
$7.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.29
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.94
|
| 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: Longevity Health Plan of New Jersey Medicare Advantage |
$3.94
|
| 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 |
$3.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
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 SUBSTITUTION
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
397021085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Medicare Advantage |
$20.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.47
|
| 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 |
$23.47
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.47
|
| Rate for Payer: Clover Medicare Advantage |
$6.15
|
| Rate for Payer: EmblemHealth Commercial |
$19.41
|
| Rate for Payer: Humana Medicare Advantage |
$6.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.47
|
| 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 |
$5.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH PTT SUBSTITUTION
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
397021085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH RA, SERUM
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86430
|
| Hospital Charge Code |
397041082
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: Aetna Medicare Advantage |
$19.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.27
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$6.14
|
| Rate for Payer: Clover Medicare Advantage |
$5.83
|
| Rate for Payer: EmblemHealth Commercial |
$18.42
|
| Rate for Payer: Humana Medicare Advantage |
$6.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.14
|
| 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 |
$4.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
CH RA, SERUM
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86430
|
| Hospital Charge Code |
397041082
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH RBC CMV NEG LEUKORED
|
Facility
|
OP
|
$990.90
|
|
|
Service Code
|
HCPCS P9051
|
| Hospital Charge Code |
397031167
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$28.14 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Aetna Commercial |
$479.43
|
| Rate for Payer: Aetna Medicare Advantage |
$571.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$639.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$639.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$176.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$639.38
|
| Rate for Payer: Cigna Commercial |
$353.31
|
| Rate for Payer: Cigna Medicare Advantage |
$176.26
|
| Rate for Payer: Clover Medicare Advantage |
$167.45
|
| Rate for Payer: EmblemHealth Commercial |
$528.78
|
| Rate for Payer: Humana Medicare Advantage |
$181.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$176.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$257.63
|
| Rate for Payer: Oxford Commercial |
$1,028.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$148.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,167.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$176.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$176.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.14
|
|
