|
CH STAIN PAS
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
397061367
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$224.58 |
| 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 |
$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 |
$92.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH STAIN, PAS
|
Facility
|
IP
|
$1,529.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061069
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$229.35 |
| Max. Negotiated Rate |
$229.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.35
|
|
|
CH STAIN, PAS
|
Facility
|
OP
|
$1,529.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061069
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$573.36 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.36
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$397.54
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.42
|
|
|
CH STAIN, PTAH
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
|
|
CH STAIN, PTAH
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$573.36 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.36
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.72
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.08
|
|
|
CH STAIN, RETICULUM
|
Facility
|
OP
|
$1,529.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$573.36 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.36
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$397.54
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.42
|
|
|
CH STAIN, RETICULUM
|
Facility
|
IP
|
$1,529.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$229.35 |
| Max. Negotiated Rate |
$229.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.35
|
|
|
CH STAIN, TRICHROME
|
Facility
|
IP
|
$1,529.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$229.35 |
| Max. Negotiated Rate |
$229.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.35
|
|
|
CH STAIN, TRICHROME
|
Facility
|
OP
|
$1,529.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$573.36 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.36
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$397.54
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.42
|
|
|
CH STAIN, VERHOEFE ELASTICA
|
Facility
|
OP
|
$1,529.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061055
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$573.36 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.36
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$397.54
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.42
|
|
|
CH STAIN, VERHOEFE ELASTICA
|
Facility
|
IP
|
$1,529.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
397061055
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$229.35 |
| Max. Negotiated Rate |
$229.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.35
|
|
|
CH THYROXINE FREE
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
397073610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$67.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.95
|
|
|
CH THYROXINE FREE
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
397073610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$226.50 |
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Medicare Advantage |
$29.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.02
|
| 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 |
$32.72
|
| Rate for Payer: Cigna Commercial |
$226.50
|
| Rate for Payer: Cigna Medicare Advantage |
$9.02
|
| Rate for Payer: Clover Medicare Advantage |
$8.57
|
| Rate for Payer: EmblemHealth Commercial |
$27.06
|
| Rate for Payer: Humana Medicare Advantage |
$9.29
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.78
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.87
|
|
|
CH TIBC
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
397071312
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$23.77
|
| Rate for Payer: Aetna Medicare Advantage |
$28.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.70
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.74
|
| Rate for Payer: Clover Medicare Advantage |
$8.30
|
| Rate for Payer: EmblemHealth Commercial |
$26.22
|
| Rate for Payer: Humana Medicare Advantage |
$9.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.74
|
| 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 |
$6.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH TIBC
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
397071312
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH TOBRAMYCIN - PEAK
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80200
|
| Hospital Charge Code |
397073146
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$43.87
|
| Rate for Payer: Aetna Medicare Advantage |
$52.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.13
|
| 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 |
$58.51
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.13
|
| Rate for Payer: Clover Medicare Advantage |
$15.32
|
| Rate for Payer: EmblemHealth Commercial |
$48.39
|
| Rate for Payer: Humana Medicare Advantage |
$16.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.13
|
| 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 |
$12.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH TOBRAMYCIN - PEAK
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80200
|
| Hospital Charge Code |
397073146
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH TOBRAMYCIN RANDOM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80200
|
| Hospital Charge Code |
397073180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH TOBRAMYCIN RANDOM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80200
|
| Hospital Charge Code |
397073180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$43.87
|
| Rate for Payer: Aetna Medicare Advantage |
$52.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.13
|
| 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 |
$58.51
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.13
|
| Rate for Payer: Clover Medicare Advantage |
$15.32
|
| Rate for Payer: EmblemHealth Commercial |
$48.39
|
| Rate for Payer: Humana Medicare Advantage |
$16.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.13
|
| 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 |
$12.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH TOBRAMYCIN TROUGH
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80200
|
| Hospital Charge Code |
397071319
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH TOBRAMYCIN TROUGH
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 80200
|
| Hospital Charge Code |
397071319
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$43.87
|
| Rate for Payer: Aetna Medicare Advantage |
$52.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.13
|
| 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 |
$58.51
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.13
|
| Rate for Payer: Clover Medicare Advantage |
$15.32
|
| Rate for Payer: EmblemHealth Commercial |
$48.39
|
| Rate for Payer: Humana Medicare Advantage |
$16.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.13
|
| 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 |
$12.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH TOTAL LIPIDS, FL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
397073054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: Aetna Medicare Advantage |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.38
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.10
|
| Rate for Payer: Clover Medicare Advantage |
$7.70
|
| Rate for Payer: EmblemHealth Commercial |
$24.30
|
| Rate for Payer: Humana Medicare Advantage |
$8.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.10
|
| 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 |
$6.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH TOTAL LIPIDS, FL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
397073054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH TOTAL PROTEIN (RANDOM)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
397073114
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$9.98
|
| Rate for Payer: Aetna Medicare Advantage |
$11.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.67
|
| 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 |
$13.31
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.67
|
| Rate for Payer: Clover Medicare Advantage |
$3.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.01
|
| Rate for Payer: Humana Medicare Advantage |
$3.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.67
|
| 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 |
$2.94
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH TOTAL PROTEIN (RANDOM)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
397073114
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
