|
CH HEMOGLOBIN F
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
397073020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.30
|
|
|
CH HEMOGLOBIN F
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
397073020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.01
|
| Rate for Payer: Aetna Medicare Advantage |
$41.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.46
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.87
|
| Rate for Payer: Clover Medicare Advantage |
$12.23
|
| Rate for Payer: EmblemHealth Commercial |
$38.61
|
| Rate for Payer: Humana Medicare Advantage |
$13.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.70
|
|
|
CH HEMOGLOBIN FLUID
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
397021292
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.15
|
|
|
CH HEMOGLOBIN FLUID
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
397021292
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$6.45
|
| Rate for Payer: Aetna Medicare Advantage |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.55
|
| Rate for Payer: Cigna Commercial |
$10.50
|
| Rate for Payer: Cigna Medicare Advantage |
$2.37
|
| Rate for Payer: Clover Medicare Advantage |
$2.25
|
| Rate for Payer: EmblemHealth Commercial |
$7.11
|
| Rate for Payer: Humana Medicare Advantage |
$2.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.56
|
|
|
CH HEMOGLOBIN FRAC & CITR
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
397072076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.75
|
|
|
CH HEMOGLOBIN FRAC & CITR
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
397072076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.01
|
| Rate for Payer: Aetna Medicare Advantage |
$41.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.46
|
| Rate for Payer: Cigna Commercial |
$102.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.87
|
| Rate for Payer: Clover Medicare Advantage |
$12.23
|
| Rate for Payer: EmblemHealth Commercial |
$38.61
|
| Rate for Payer: Humana Medicare Advantage |
$13.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.43
|
|
|
CH HEMOGLOBIN FREE PLASMA
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 83051
|
| Hospital Charge Code |
397072077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$19.88
|
| Rate for Payer: Aetna Medicare Advantage |
$23.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.39
|
| Rate for Payer: Cigna Commercial |
$61.50
|
| Rate for Payer: Cigna Medicare Advantage |
$7.31
|
| Rate for Payer: Clover Medicare Advantage |
$6.94
|
| Rate for Payer: EmblemHealth Commercial |
$21.93
|
| Rate for Payer: Humana Medicare Advantage |
$7.53
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.85
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.26
|
|
|
CH HEMOGLOBIN FREE PLASMA
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 83051
|
| Hospital Charge Code |
397072077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.45 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.45
|
|
|
CH HEMOGLOBIN (H&H)
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
397021300
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.15
|
|
|
CH HEMOGLOBIN (H&H)
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
397021300
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$6.45
|
| Rate for Payer: Aetna Medicare Advantage |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.55
|
| Rate for Payer: Cigna Commercial |
$10.50
|
| Rate for Payer: Cigna Medicare Advantage |
$2.37
|
| Rate for Payer: Clover Medicare Advantage |
$2.25
|
| Rate for Payer: EmblemHealth Commercial |
$7.11
|
| Rate for Payer: Humana Medicare Advantage |
$2.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.56
|
|
|
CH HEMOGRAM
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
397021044
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$23.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.35
|
| 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 |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.35
|
| Rate for Payer: Cigna Commercial |
$91.50
|
| 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 |
$54.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| 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 |
$4.85
|
|
|
CH HEMOGRAM
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
397021044
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.45
|
|
|
CH HEMOSIDERIN
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 83070
|
| Hospital Charge Code |
397073021
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
CH HEMOSIDERIN
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 83070
|
| Hospital Charge Code |
397073021
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$12.92
|
| Rate for Payer: Aetna Medicare Advantage |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: Cigna Medicare Advantage |
$4.75
|
| Rate for Payer: Clover Medicare Advantage |
$4.51
|
| Rate for Payer: EmblemHealth Commercial |
$14.25
|
| Rate for Payer: Humana Medicare Advantage |
$4.89
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.77
|
|
|
CH HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
397071304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$22.22
|
| Rate for Payer: Aetna Medicare Advantage |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.49
|
| Rate for Payer: Cigna Commercial |
$28.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.17
|
| Rate for Payer: Clover Medicare Advantage |
$7.76
|
| Rate for Payer: EmblemHealth Commercial |
$24.51
|
| Rate for Payer: Humana Medicare Advantage |
$8.42
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.54
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.48
|
|
|
CH HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
397071304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
|
|
CH HEPATITIS A AB IGG TOTAL
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
397072078
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Medicare Advantage |
$40.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.72
|
| Rate for Payer: Cigna Commercial |
$39.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.39
|
| Rate for Payer: Clover Medicare Advantage |
$11.77
|
| Rate for Payer: EmblemHealth Commercial |
$37.17
|
| Rate for Payer: Humana Medicare Advantage |
$12.76
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.07
|
|
|
CH HEPATITIS A AB IGG TOTAL
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
397072078
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.70
|
|
|
CH HEPATITIS A ANTIBODY, IGM
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
397071170
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$30.63
|
| Rate for Payer: Aetna Medicare Advantage |
$36.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.65
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$11.26
|
| Rate for Payer: Clover Medicare Advantage |
$10.70
|
| Rate for Payer: EmblemHealth Commercial |
$33.78
|
| Rate for Payer: Humana Medicare Advantage |
$11.60
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.28
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.01
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
CH HEPATITIS A ANTIBODY, IGM
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
397071170
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH HEPATITIS B CORE ANT, IGM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
397071168
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH HEPATITIS B CORE ANT, IGM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
397071168
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$32.01
|
| Rate for Payer: Aetna Medicare Advantage |
$38.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.49
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.77
|
| Rate for Payer: Clover Medicare Advantage |
$11.18
|
| Rate for Payer: EmblemHealth Commercial |
$35.31
|
| Rate for Payer: Humana Medicare Advantage |
$12.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH HEPATITIS B CORE, TOTAL
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
397073053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.00
|
|
|
CH HEPATITIS B CORE, TOTAL
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
397073053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare Advantage |
$39.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.50
|
| Rate for Payer: Cigna Commercial |
$70.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.45
|
| Rate for Payer: EmblemHealth Commercial |
$36.15
|
| Rate for Payer: Humana Medicare Advantage |
$12.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.71
|
|
|
CH HEPATITIS B DNA(QUAN)
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
397073193
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$116.52
|
| Rate for Payer: Aetna Medicare Advantage |
$138.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$154.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.64
|
| Rate for Payer: Cigna Commercial |
$255.00
|
| Rate for Payer: Cigna Medicare Advantage |
$42.84
|
| Rate for Payer: Clover Medicare Advantage |
$40.70
|
| Rate for Payer: EmblemHealth Commercial |
$128.52
|
| Rate for Payer: Humana Medicare Advantage |
$44.13
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$42.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$42.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.52
|
|
