|
CH TOXOPLASMA IGG/IGM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
397043215
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$195.00
|
| 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 |
$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 |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH TOXOPLASMA IGG/IGM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
397043215
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH TYPE & SCREEN
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
397031016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$173.57 |
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Aetna Medicare Advantage |
$31.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35.44
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: Cigna Medicare Advantage |
$9.77
|
| Rate for Payer: Clover Medicare Advantage |
$9.28
|
| Rate for Payer: EmblemHealth Commercial |
$29.31
|
| Rate for Payer: Humana Medicare Advantage |
$10.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.77
|
| 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 |
$7.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
CH TYPE & SCREEN
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
397031016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH UREA NITROGEN (RANDOM)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
397073108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$15.12
|
| Rate for Payer: Aetna Medicare Advantage |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.56
|
| 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 |
$20.17
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.56
|
| Rate for Payer: Clover Medicare Advantage |
$5.28
|
| Rate for Payer: EmblemHealth Commercial |
$16.68
|
| Rate for Payer: Humana Medicare Advantage |
$5.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.56
|
| 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 |
$4.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH UREA NITROGEN (RANDOM)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
397073108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH URINALYSIS ROUTINE
|
Facility
|
IP
|
$790.84
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
397071008
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$118.63 |
| Max. Negotiated Rate |
$118.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.63
|
|
|
CH URINALYSIS ROUTINE
|
Facility
|
OP
|
$790.84
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
397071008
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$395.42 |
| Rate for Payer: Aetna Commercial |
$8.62
|
| Rate for Payer: Aetna Medicare Advantage |
$10.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.50
|
| Rate for Payer: Cigna Commercial |
$395.42
|
| Rate for Payer: Cigna Medicare Advantage |
$3.17
|
| Rate for Payer: Clover Medicare Advantage |
$3.01
|
| Rate for Payer: EmblemHealth Commercial |
$9.51
|
| Rate for Payer: Humana Medicare Advantage |
$3.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$205.62
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.54
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.46
|
|
|
CH VARICELLA ZOSTER DNA PCR
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
397073345
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$129.30 |
| Max. Negotiated Rate |
$129.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.30
|
|
|
CH VARICELLA ZOSTER DNA PCR
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
397073345
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$431.00 |
| 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 |
$130.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.29
|
| Rate for Payer: Cigna Commercial |
$431.00
|
| 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 |
$224.12
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.30
|
| 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 |
$24.48
|
|
|
CH VARICELLA ZOSTER IGG
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
397041137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| 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 |
$46.72
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| 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 |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH VARICELLA ZOSTER IGG
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
397041137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH VENOUS BLOOD GAS
|
Facility
|
IP
|
$1,255.57
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
397360005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.34 |
| Max. Negotiated Rate |
$188.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.34
|
|
|
CH VENOUS BLOOD GAS
|
Facility
|
OP
|
$1,255.57
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
397360005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$627.78 |
| Rate for Payer: Aetna Commercial |
$70.91
|
| Rate for Payer: Aetna Medicare Advantage |
$84.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$94.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$94.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$94.57
|
| Rate for Payer: Cigna Commercial |
$627.78
|
| Rate for Payer: Cigna Medicare Advantage |
$26.07
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$26.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$326.45
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.66
|
|
|
CH VIP
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
397072020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$96.10
|
| Rate for Payer: Aetna Medicare Advantage |
$114.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$128.16
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$35.33
|
| Rate for Payer: Clover Medicare Advantage |
$33.56
|
| Rate for Payer: EmblemHealth Commercial |
$105.99
|
| Rate for Payer: Humana Medicare Advantage |
$36.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.33
|
| 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 |
$28.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH VIP
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
397072020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH WBC & DIFFERENTIAL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
397021061
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: Aetna Medicare Advantage |
$8.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.21
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$2.54
|
| Rate for Payer: Clover Medicare Advantage |
$2.41
|
| Rate for Payer: EmblemHealth Commercial |
$7.62
|
| Rate for Payer: Humana Medicare Advantage |
$2.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.54
|
| 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 |
$2.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
CH WBC & DIFFERENTIAL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
397021061
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CHYLMD TRACH DNA AMP PROBE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
3990245A
|
|
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
|
|
|
CHYLMD TRACH DNA AMP PROBE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
3990245A
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CIDOFOVIR 375 MG 5ML VIAL
|
Facility
|
IP
|
$24,083.49
|
|
|
Service Code
|
HCPCS J0740
|
| Hospital Charge Code |
60630119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,612.52 |
| Max. Negotiated Rate |
$5,828.20 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,828.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,612.52
|
|
|
CIDOFOVIR 375 MG 5ML VIAL
|
Facility
|
OP
|
$24,083.49
|
|
|
Service Code
|
HCPCS J0740
|
| Hospital Charge Code |
60630119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$532.75 |
| Max. Negotiated Rate |
$5,828.20 |
| Rate for Payer: Aetna Commercial |
$1,525.35
|
| Rate for Payer: Aetna Medicare Advantage |
$1,816.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,034.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,034.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$560.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$594.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,034.27
|
| Rate for Payer: Cigna Medicare Advantage |
$560.79
|
| Rate for Payer: Clover Medicare Advantage |
$532.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,682.37
|
| Rate for Payer: Humana Medicare Advantage |
$577.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$560.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,828.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,612.52
|
| Rate for Payer: UnitedHealthcare Community & State |
$761.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$560.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$560.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$683.97
|
|
|
CILOSTAZOL 100 MG TAB UD
|
Facility
|
IP
|
$12.19
|
|
|
Service Code
|
NDC 185022360
|
| Hospital Charge Code |
60629892
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.83
|
|
|
CILOSTAZOL 100 MG TAB UD
|
Facility
|
OP
|
$12.19
|
|
|
Service Code
|
NDC 185022360
|
| Hospital Charge Code |
60629892
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna Commercial |
$4.63
|
| Rate for Payer: Aetna Medicare Advantage |
$3.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.11
|
| Rate for Payer: Cigna Commercial |
$6.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.17
|
| Rate for Payer: Oxford Commercial |
$2.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.35
|
|
|
CILOSTAZOL 50 MG TAB UD
|
Facility
|
IP
|
$12.19
|
|
|
Service Code
|
NDC 185012360
|
| Hospital Charge Code |
60629893
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.83
|
|
