|
CH HISTAMINE WHOLE BLOOD
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
HCPCS 83088
|
| Hospital Charge Code |
397072084
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.50
|
|
|
CH HIV 1&2 ANTIBODIES
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
397043273
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$37.29
|
| Rate for Payer: Aetna Medicare Advantage |
$44.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.49
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$13.71
|
| Rate for Payer: Clover Medicare Advantage |
$13.02
|
| Rate for Payer: EmblemHealth Commercial |
$41.13
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.71
|
| 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 |
$10.97
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
CH HIV 1&2 ANTIBODIES
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
397043273
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
CH HIV-1 CORECEPTOR TROPISM
|
Facility
|
OP
|
$3,644.00
|
|
|
Service Code
|
HCPCS 87906
|
| Hospital Charge Code |
397071376
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$96.57 |
| Max. Negotiated Rate |
$1,822.00 |
| Rate for Payer: Aetna Commercial |
$350.15
|
| Rate for Payer: Aetna Medicare Advantage |
$417.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$464.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$464.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$128.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$464.68
|
| Rate for Payer: Cigna Commercial |
$1,822.00
|
| Rate for Payer: Cigna Medicare Advantage |
$128.73
|
| Rate for Payer: Clover Medicare Advantage |
$122.29
|
| Rate for Payer: EmblemHealth Commercial |
$386.19
|
| Rate for Payer: Humana Medicare Advantage |
$132.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$128.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,093.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$546.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$102.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$128.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$128.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.57
|
|
|
CH HIV-1 CORECEPTOR TROPISM
|
Facility
|
IP
|
$3,644.00
|
|
|
Service Code
|
HCPCS 87906
|
| Hospital Charge Code |
397071376
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$546.60 |
| Max. Negotiated Rate |
$546.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$546.60
|
|
|
CH HIV1 GENOTYPEPR PLUS
|
Facility
|
IP
|
$1,587.00
|
|
|
Service Code
|
HCPCS 87901
|
| Hospital Charge Code |
397073194
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$238.05 |
| Max. Negotiated Rate |
$238.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$238.05
|
|
|
CH HIV1 GENOTYPEPR PLUS
|
Facility
|
OP
|
$1,587.00
|
|
|
Service Code
|
HCPCS 87901
|
| Hospital Charge Code |
397073194
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.06 |
| Max. Negotiated Rate |
$929.32 |
| Rate for Payer: Aetna Commercial |
$700.26
|
| Rate for Payer: Aetna Medicare Advantage |
$834.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$929.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$929.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$929.32
|
| Rate for Payer: Cigna Commercial |
$793.50
|
| Rate for Payer: Cigna Medicare Advantage |
$257.45
|
| Rate for Payer: Clover Medicare Advantage |
$244.58
|
| Rate for Payer: EmblemHealth Commercial |
$772.35
|
| Rate for Payer: Humana Medicare Advantage |
$265.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$257.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$476.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$238.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$205.96
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$257.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$257.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.06
|
|
|
CH HIV-1 RNA, QT RT-PCR,CSF
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
397071508
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$307.19 |
| Rate for Payer: Aetna Commercial |
$231.47
|
| Rate for Payer: Aetna Medicare Advantage |
$275.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$307.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$307.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$226.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$307.19
|
| Rate for Payer: Cigna Commercial |
$254.50
|
| Rate for Payer: Cigna Medicare Advantage |
$85.10
|
| Rate for Payer: Clover Medicare Advantage |
$80.84
|
| Rate for Payer: EmblemHealth Commercial |
$255.30
|
| Rate for Payer: Humana Medicare Advantage |
$87.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.08
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.49
|
|
|
CH HIV-1 RNA, QT RT-PCR,CSF
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
397071508
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.35 |
| Max. Negotiated Rate |
$76.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.35
|
|
|
CH HIV-1 RNA QUANT PCR, CSF
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
397073640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$307.19 |
| Rate for Payer: Aetna Commercial |
$231.47
|
| Rate for Payer: Aetna Medicare Advantage |
$275.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$307.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$307.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$226.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$307.19
|
| Rate for Payer: Cigna Commercial |
$286.50
|
| Rate for Payer: Cigna Medicare Advantage |
$85.10
|
| Rate for Payer: Clover Medicare Advantage |
$80.84
|
| Rate for Payer: EmblemHealth Commercial |
$255.30
|
| Rate for Payer: Humana Medicare Advantage |
$87.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$171.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.08
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.18
|
|
|
CH HIV-1 RNA QUANT PCR, CSF
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
397073640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.95 |
| Max. Negotiated Rate |
$85.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.95
|
|
|
CH HIV-2 AB, IMMUNOBLOT
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
397071441
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$52.63
|
| Rate for Payer: Aetna Medicare Advantage |
$62.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$69.85
|
| Rate for Payer: Cigna Commercial |
$58.50
|
| Rate for Payer: Cigna Medicare Advantage |
$19.35
|
| Rate for Payer: Clover Medicare Advantage |
$18.38
|
| Rate for Payer: EmblemHealth Commercial |
$58.05
|
| Rate for Payer: Humana Medicare Advantage |
$19.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.10
|
|
|
CH HIV-2 AB, IMMUNOBLOT
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
397071441
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.55
|
|
|
CH HIV-2 AB, IMMUNOBLOT
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
397071523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$52.63
|
| Rate for Payer: Aetna Medicare Advantage |
$62.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$69.85
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: Cigna Medicare Advantage |
$19.35
|
| Rate for Payer: Clover Medicare Advantage |
$18.38
|
| Rate for Payer: EmblemHealth Commercial |
$58.05
|
| Rate for Payer: Humana Medicare Advantage |
$19.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.95
|
|
|
CH HIV-2 AB, IMMUNOBLOT
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
397071523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
CH HIV PHENOSENSE G
|
Facility
|
IP
|
$7,514.00
|
|
|
Service Code
|
HCPCS 87903
|
| Hospital Charge Code |
397071378
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,127.10 |
| Max. Negotiated Rate |
$1,127.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,127.10
|
|
|
CH HIV PHENOSENSE G
|
Facility
|
OP
|
$7,514.00
|
|
|
Service Code
|
HCPCS 87903
|
| Hospital Charge Code |
397071378
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$3,757.00 |
| Rate for Payer: Aetna Commercial |
$1,329.16
|
| Rate for Payer: Aetna Medicare Advantage |
$1,583.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,763.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,763.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$488.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$535.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,763.92
|
| Rate for Payer: Cigna Commercial |
$3,757.00
|
| Rate for Payer: Cigna Medicare Advantage |
$488.66
|
| Rate for Payer: Clover Medicare Advantage |
$464.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,465.98
|
| Rate for Payer: Humana Medicare Advantage |
$503.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$488.66
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,254.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,127.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$390.93
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$488.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$488.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$199.12
|
|
|
CH HIV PHENOTYPE
|
Facility
|
IP
|
$3,073.00
|
|
|
Service Code
|
HCPCS 83892
|
| Hospital Charge Code |
397073567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$460.95 |
| Max. Negotiated Rate |
$460.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$460.95
|
|
|
CH HIV PHENOTYPE
|
Facility
|
OP
|
$3,073.00
|
|
|
Service Code
|
HCPCS 83892
|
| Hospital Charge Code |
397073567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.06 |
| Max. Negotiated Rate |
$1,536.50 |
| Rate for Payer: Aetna Commercial |
$1,167.74
|
| Rate for Payer: Aetna Medicare Advantage |
$921.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$783.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$783.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$783.62
|
| Rate for Payer: Cigna Commercial |
$1,536.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$921.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$460.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$74.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$81.43
|
|
|
CH HIV ULTRA QUANT
|
Facility
|
IP
|
$1,084.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
397071048
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$162.60 |
| Max. Negotiated Rate |
$162.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.60
|
|
|
CH HIV ULTRA QUANT
|
Facility
|
OP
|
$1,084.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
397071048
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$542.00 |
| Rate for Payer: Aetna Commercial |
$231.47
|
| Rate for Payer: Aetna Medicare Advantage |
$275.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$307.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$307.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$226.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$307.19
|
| Rate for Payer: Cigna Commercial |
$542.00
|
| Rate for Payer: Cigna Medicare Advantage |
$85.10
|
| Rate for Payer: Clover Medicare Advantage |
$80.84
|
| Rate for Payer: EmblemHealth Commercial |
$255.30
|
| Rate for Payer: Humana Medicare Advantage |
$87.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$325.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.08
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.73
|
|
|
CH HLA B27
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
HCPCS 86812
|
| Hospital Charge Code |
397071079
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Medicare Advantage |
$83.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.17
|
| Rate for Payer: Cigna Commercial |
$116.50
|
| Rate for Payer: Cigna Medicare Advantage |
$25.81
|
| Rate for Payer: Clover Medicare Advantage |
$24.52
|
| Rate for Payer: EmblemHealth Commercial |
$77.43
|
| Rate for Payer: Humana Medicare Advantage |
$26.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$69.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.17
|
|
|
CH HLA B27
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
HCPCS 86812
|
| Hospital Charge Code |
397071079
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.95
|
|
|
CH HLA DR TYPING
|
Facility
|
OP
|
$743.00
|
|
|
Service Code
|
HCPCS 86817
|
| Hospital Charge Code |
397073324
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$383.13 |
| Rate for Payer: Aetna Commercial |
$288.70
|
| Rate for Payer: Aetna Medicare Advantage |
$343.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$383.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$383.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$106.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$383.13
|
| Rate for Payer: Cigna Commercial |
$371.50
|
| Rate for Payer: Cigna Medicare Advantage |
$106.14
|
| Rate for Payer: Clover Medicare Advantage |
$100.83
|
| Rate for Payer: EmblemHealth Commercial |
$318.42
|
| Rate for Payer: Humana Medicare Advantage |
$109.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$106.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$222.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$84.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$106.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$106.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.69
|
|
|
CH HLA DR TYPING
|
Facility
|
IP
|
$743.00
|
|
|
Service Code
|
HCPCS 86817
|
| Hospital Charge Code |
397073324
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$111.45 |
| Max. Negotiated Rate |
$111.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.45
|
|
