|
Chronic Uticaria panel C
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
39708021C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$39.58
|
| Rate for Payer: Aetna Medicare Advantage |
$47.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.78
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.55
|
| Rate for Payer: Clover Medicare Advantage |
$13.82
|
| Rate for Payer: EmblemHealth Commercial |
$43.65
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.55
|
| 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 |
$11.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
Chronic Uticaria panel D
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
39708021D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
Chronic Uticaria panel D
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
39708021D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$43.28
|
| Rate for Payer: Aetna Medicare Advantage |
$51.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.71
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$15.91
|
| Rate for Payer: Clover Medicare Advantage |
$15.11
|
| Rate for Payer: EmblemHealth Commercial |
$47.73
|
| Rate for Payer: Humana Medicare Advantage |
$16.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.91
|
| 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 |
$12.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CHRONOS 10cc
|
Facility
|
OP
|
$2,960.20
|
|
| Hospital Charge Code |
270639428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.07 |
| Max. Negotiated Rate |
$1,480.10 |
| Rate for Payer: Aetna Commercial |
$1,124.88
|
| Rate for Payer: Aetna Medicare Advantage |
$888.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$754.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$754.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$592.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$754.85
|
| Rate for Payer: Cigna Commercial |
$1,480.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$716.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$444.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$93.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$84.07
|
|
|
CHRONOS 10cc
|
Facility
|
IP
|
$2,960.20
|
|
| Hospital Charge Code |
270639428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.03 |
| Max. Negotiated Rate |
$716.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$592.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$716.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$444.03
|
|
|
CHRONOS GRANULE 1.4-2.8mm/20cc
|
Facility
|
OP
|
$4,227.10
|
|
| Hospital Charge Code |
270645879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$2,113.55 |
| Rate for Payer: Aetna Commercial |
$1,606.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,268.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,077.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,077.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$845.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,077.91
|
| Rate for Payer: Cigna Commercial |
$2,113.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,022.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$133.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$120.05
|
|
|
CHRONOS GRANULE 1.4-2.8mm/20cc
|
Facility
|
IP
|
$4,227.10
|
|
| Hospital Charge Code |
270645879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.07 |
| Max. Negotiated Rate |
$1,022.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$845.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,022.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$634.07
|
|
|
CH ROSETTE TEST
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85461
|
| Hospital Charge Code |
397031055
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH ROSETTE TEST
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85461
|
| Hospital Charge Code |
397031055
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Medicare Advantage |
$30.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.95
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$9.36
|
| Rate for Payer: Clover Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$28.08
|
| Rate for Payer: Humana Medicare Advantage |
$9.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.36
|
| 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 |
$7.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CHROSOME COUNT 5C,1KW BANDING
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
HCPCS 88261
|
| Hospital Charge Code |
38477215
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$186.60 |
| Max. Negotiated Rate |
$186.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.60
|
|
|
CHROSOME COUNT 5C,1KW BANDING
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
HCPCS 88261
|
| Hospital Charge Code |
38477215
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$35.33 |
| 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 |
$622.00
|
| 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 |
$323.44
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$264.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$264.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.33
|
|
|
CH ROTAVIRUS AG
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87425
|
| Hospital Charge Code |
397041145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Medicare Advantage |
$38.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.46
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.98
|
| Rate for Payer: Clover Medicare Advantage |
$11.38
|
| Rate for Payer: EmblemHealth Commercial |
$35.94
|
| Rate for Payer: Humana Medicare Advantage |
$12.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.98
|
| 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 |
$9.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH ROTAVIRUS AG
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87425
|
| Hospital Charge Code |
397041145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH RUBELLA AB IGG
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
397041197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH RUBELLA AB IGG
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
397041197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare Advantage |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.39
|
| 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 |
$52.20
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$14.39
|
| Rate for Payer: Clover Medicare Advantage |
$13.67
|
| Rate for Payer: EmblemHealth Commercial |
$43.17
|
| Rate for Payer: Humana Medicare Advantage |
$14.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.39
|
| 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 |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
CH SECOND MRSA SCREEN
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397043274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$23.45
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.62
|
| 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 |
$31.27
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$8.62
|
| Rate for Payer: Clover Medicare Advantage |
$8.19
|
| Rate for Payer: EmblemHealth Commercial |
$25.86
|
| Rate for Payer: Humana Medicare Advantage |
$8.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.62
|
| 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 |
$6.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
CH SECOND MRSA SCREEN
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
397043274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH SELENIUM
|
Facility
|
OP
|
$883.27
|
|
|
Service Code
|
HCPCS 84255
|
| Hospital Charge Code |
397071434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$441.63 |
| Rate for Payer: Aetna Commercial |
$69.44
|
| Rate for Payer: Aetna Medicare Advantage |
$82.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.61
|
| Rate for Payer: Cigna Commercial |
$441.63
|
| Rate for Payer: Cigna Medicare Advantage |
$25.53
|
| Rate for Payer: Clover Medicare Advantage |
$24.25
|
| Rate for Payer: EmblemHealth Commercial |
$76.59
|
| Rate for Payer: Humana Medicare Advantage |
$26.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$229.65
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.08
|
|
|
CH SELENIUM
|
Facility
|
IP
|
$883.27
|
|
|
Service Code
|
HCPCS 84255
|
| Hospital Charge Code |
397071434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.49 |
| Max. Negotiated Rate |
$132.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.49
|
|
|
CH SHIGA-LIKE TOXIN AG EIA
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87427
|
| Hospital Charge Code |
397071491
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH SHIGA-LIKE TOXIN AG EIA
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87427
|
| Hospital Charge Code |
397071491
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Medicare Advantage |
$38.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.46
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.98
|
| Rate for Payer: Clover Medicare Advantage |
$11.38
|
| Rate for Payer: EmblemHealth Commercial |
$35.94
|
| Rate for Payer: Humana Medicare Advantage |
$12.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.98
|
| 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 |
$9.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH SICKLE CELL TEST
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
397021056
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH SICKLE CELL TEST
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
397021056
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$14.99
|
| Rate for Payer: Aetna Medicare Advantage |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.51
|
| 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 |
$19.99
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.51
|
| Rate for Payer: Clover Medicare Advantage |
$5.23
|
| Rate for Payer: EmblemHealth Commercial |
$16.53
|
| Rate for Payer: Humana Medicare Advantage |
$5.68
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.51
|
| 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 |
$4.41
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH SODIUM RANDOM URINE
|
Facility
|
IP
|
$97.57
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
397073111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$14.64 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.64
|
|
|
CH SODIUM RANDOM URINE
|
Facility
|
OP
|
$97.57
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
397073111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Medicare Advantage |
$16.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.36
|
| Rate for Payer: Cigna Commercial |
$48.78
|
| Rate for Payer: Cigna Medicare Advantage |
$5.06
|
| Rate for Payer: Clover Medicare Advantage |
$4.81
|
| Rate for Payer: EmblemHealth Commercial |
$15.18
|
| Rate for Payer: Humana Medicare Advantage |
$5.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.37
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.77
|
|
