|
CH HLA PANEL
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
HCPCS 86813
|
| Hospital Charge Code |
397072086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$157.76
|
| Rate for Payer: Aetna Medicare Advantage |
$187.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$209.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$209.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$209.36
|
| Rate for Payer: Cigna Commercial |
$275.50
|
| Rate for Payer: Cigna Medicare Advantage |
$58.00
|
| Rate for Payer: Clover Medicare Advantage |
$55.10
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Humana Medicare Advantage |
$59.74
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$58.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$58.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$58.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.60
|
|
|
CH HLA PANEL
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
HCPCS 86813
|
| Hospital Charge Code |
397072086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
|
|
CH HLA TYPING 3X
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
HCPCS 86813
|
| Hospital Charge Code |
397073323
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$209.36 |
| Rate for Payer: Aetna Commercial |
$157.76
|
| Rate for Payer: Aetna Medicare Advantage |
$187.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$209.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$209.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$209.36
|
| Rate for Payer: Cigna Commercial |
$179.00
|
| Rate for Payer: Cigna Medicare Advantage |
$58.00
|
| Rate for Payer: Clover Medicare Advantage |
$55.10
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Humana Medicare Advantage |
$59.74
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$58.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$107.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.40
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$58.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$58.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.49
|
|
|
CH HLA TYPING 3X
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
HCPCS 86813
|
| Hospital Charge Code |
397073323
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$53.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.70
|
|
|
CH HLA TYPING FOR NARCOLEPSY
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
HCPCS 83891
|
| Hospital Charge Code |
397071499
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$138.30 |
| Max. Negotiated Rate |
$138.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.30
|
|
|
CH HLA TYPING FOR NARCOLEPSY
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
HCPCS 83891
|
| Hospital Charge Code |
397071499
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$461.00 |
| Rate for Payer: Aetna Commercial |
$350.36
|
| Rate for Payer: Aetna Medicare Advantage |
$276.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.11
|
| Rate for Payer: Cigna Commercial |
$461.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$276.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.43
|
|
|
CH HOMOCYSTEINE
|
Facility
|
OP
|
$903.82
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
397073277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$451.91 |
| Rate for Payer: Aetna Commercial |
$48.74
|
| Rate for Payer: Aetna Medicare Advantage |
$58.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.69
|
| Rate for Payer: Cigna Commercial |
$451.91
|
| Rate for Payer: Cigna Medicare Advantage |
$17.92
|
| Rate for Payer: Clover Medicare Advantage |
$17.02
|
| Rate for Payer: EmblemHealth Commercial |
$53.76
|
| Rate for Payer: Humana Medicare Advantage |
$18.46
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.15
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.95
|
|
|
CH HOMOCYSTEINE
|
Facility
|
IP
|
$903.82
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
397073277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$135.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.57
|
|
|
CH HOMOCYSTINE PLASMA
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
397072088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna Commercial |
$48.74
|
| Rate for Payer: Aetna Medicare Advantage |
$58.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.69
|
| Rate for Payer: Cigna Commercial |
$243.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.92
|
| Rate for Payer: Clover Medicare Advantage |
$17.02
|
| Rate for Payer: EmblemHealth Commercial |
$53.76
|
| Rate for Payer: Humana Medicare Advantage |
$18.46
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.88
|
|
|
CH HOMOCYSTINE PLASMA
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
397072088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.90 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.90
|
|
|
CH HOMOCYSTINE URINE
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
397072087
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$335.50 |
| Rate for Payer: Aetna Commercial |
$62.51
|
| Rate for Payer: Aetna Medicare Advantage |
$74.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.95
|
| Rate for Payer: Cigna Commercial |
$335.50
|
| Rate for Payer: Cigna Medicare Advantage |
$22.98
|
| Rate for Payer: Clover Medicare Advantage |
$21.83
|
| Rate for Payer: EmblemHealth Commercial |
$68.94
|
| Rate for Payer: Humana Medicare Advantage |
$23.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.78
|
|
|
CH HOMOCYSTINE URINE
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
397072087
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.65 |
| Max. Negotiated Rate |
$100.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.65
|
|
|
CH HOMOVANILLIC ACID, URINE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83150
|
| Hospital Charge Code |
397070016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CH HOMOVANILLIC ACID, URINE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83150
|
| Hospital Charge Code |
397070016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$60.96
|
| Rate for Payer: Aetna Medicare Advantage |
$72.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$80.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$80.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$80.89
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.41
|
| Rate for Payer: Clover Medicare Advantage |
$21.29
|
| Rate for Payer: EmblemHealth Commercial |
$67.23
|
| Rate for Payer: Humana Medicare Advantage |
$23.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.41
|
| 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 |
$17.93
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CH H PYLORI AB IGA
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
397073625
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.82
|
| Rate for Payer: Cigna Commercial |
$63.50
|
| Rate for Payer: Cigna Medicare Advantage |
$16.85
|
| Rate for Payer: Clover Medicare Advantage |
$16.01
|
| Rate for Payer: EmblemHealth Commercial |
$50.55
|
| Rate for Payer: Humana Medicare Advantage |
$17.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.37
|
|
|
CH H PYLORI AB IGA
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
397073625
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.05 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.05
|
|
|
CH H.PYLORI AB (IGA),ELISA
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
397073641
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.05
|
|
|
CH H.PYLORI AB (IGA),ELISA
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
397073641
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$253.50 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.82
|
| Rate for Payer: Cigna Commercial |
$253.50
|
| Rate for Payer: Cigna Medicare Advantage |
$16.85
|
| Rate for Payer: Clover Medicare Advantage |
$16.01
|
| Rate for Payer: EmblemHealth Commercial |
$50.55
|
| Rate for Payer: Humana Medicare Advantage |
$17.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.44
|
|
|
CH H.PYLORI ANTIGEN
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
397073605
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.24
|
| 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 |
$12.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.24
|
| Rate for Payer: Cigna Commercial |
$37.50
|
| 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 |
$22.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| 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 |
$1.99
|
|
|
CH H.PYLORI ANTIGEN
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
397073605
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.25
|
|
|
CH H.PYLORI, IMMUNO 1ST
|
Facility
|
IP
|
$1,082.30
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
397061372
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$162.34 |
| Max. Negotiated Rate |
$162.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.34
|
|
|
CH H.PYLORI, IMMUNO 1ST
|
Facility
|
OP
|
$1,082.30
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
397061372
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$730.60 |
| Rate for Payer: Aetna Commercial |
$550.53
|
| Rate for Payer: Aetna Medicare Advantage |
$655.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$730.60
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$202.40
|
| Rate for Payer: Clover Medicare Advantage |
$192.28
|
| Rate for Payer: EmblemHealth Commercial |
$607.20
|
| Rate for Payer: Humana Medicare Advantage |
$208.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$202.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$324.69
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$86.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.68
|
|
|
CH H PYLORI SERUM
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
397041254
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$69.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.60
|
|
|
CH H PYLORI SERUM
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
397041254
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$232.00 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.82
|
| Rate for Payer: Cigna Commercial |
$232.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.85
|
| Rate for Payer: Clover Medicare Advantage |
$16.01
|
| Rate for Payer: EmblemHealth Commercial |
$50.55
|
| Rate for Payer: Humana Medicare Advantage |
$17.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.30
|
|
|
CH HTLV-I/II ABS CSF (LIA)
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
397073636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$121.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$121.80
|
|
