|
CHROMOSOME ANALYSIS, LEUKEMIA
|
Facility
|
IP
|
$2,149.65
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
3009156
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$322.45 |
| Max. Negotiated Rate |
$322.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$322.45
|
|
|
CHROMOSOME ANALYSIS, LEUKEMIA
|
Facility
|
OP
|
$2,149.65
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
3009156
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$1,074.83 |
| Rate for Payer: Aetna Commercial |
$341.33
|
| Rate for Payer: Aetna Medicare Advantage |
$406.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$452.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$452.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$452.98
|
| Rate for Payer: Cigna Commercial |
$1,074.83
|
| Rate for Payer: Cigna Medicare Advantage |
$125.49
|
| Rate for Payer: Clover Medicare Advantage |
$119.22
|
| Rate for Payer: EmblemHealth Commercial |
$376.47
|
| Rate for Payer: Humana Medicare Advantage |
$129.25
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$125.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$644.89
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$322.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$100.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$125.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.97
|
|
|
CHROMOSOME ANALYSIS,TISSUE
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 88233
|
| Hospital Charge Code |
38474109
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CHROMOSOME ANALYSIS,TISSUE
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 88233
|
| Hospital Charge Code |
38474109
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$507.99 |
| Rate for Payer: Aetna Commercial |
$382.79
|
| Rate for Payer: Aetna Medicare Advantage |
$455.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$507.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$507.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$140.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$507.99
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: Cigna Medicare Advantage |
$140.73
|
| Rate for Payer: Clover Medicare Advantage |
$133.69
|
| Rate for Payer: EmblemHealth Commercial |
$422.19
|
| Rate for Payer: Humana Medicare Advantage |
$144.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$140.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$112.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$140.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
CHROMOSOME ANALYZE 20-25 CELLS
|
Facility
|
IP
|
$882.69
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
38477208
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$132.40 |
| Max. Negotiated Rate |
$132.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.40
|
|
|
CHROMOSOME ANALYZE 20-25 CELLS
|
Facility
|
OP
|
$882.69
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
38477208
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna Commercial |
$393.34
|
| Rate for Payer: Aetna Medicare Advantage |
$468.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$522.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$522.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$144.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$522.00
|
| Rate for Payer: Cigna Commercial |
$441.35
|
| Rate for Payer: Cigna Medicare Advantage |
$144.61
|
| Rate for Payer: Clover Medicare Advantage |
$137.38
|
| Rate for Payer: EmblemHealth Commercial |
$433.83
|
| Rate for Payer: Humana Medicare Advantage |
$148.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$144.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$264.81
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$115.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$144.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.39
|
|
|
CHROMOSOME BREAKAGE STUDY
|
Facility
|
IP
|
$2,082.00
|
|
|
Service Code
|
HCPCS 88248
|
| Hospital Charge Code |
38474100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$312.30 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$312.30
|
|
|
CHROMOSOME BREAKAGE STUDY
|
Facility
|
OP
|
$2,082.00
|
|
|
Service Code
|
HCPCS 88248
|
| Hospital Charge Code |
38474100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$1,041.00 |
| Rate for Payer: Aetna Commercial |
$471.02
|
| Rate for Payer: Aetna Medicare Advantage |
$561.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$625.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$625.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$173.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$625.09
|
| Rate for Payer: Cigna Commercial |
$1,041.00
|
| Rate for Payer: Cigna Medicare Advantage |
$173.17
|
| Rate for Payer: Clover Medicare Advantage |
$164.51
|
| Rate for Payer: EmblemHealth Commercial |
$519.51
|
| Rate for Payer: Humana Medicare Advantage |
$178.37
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$173.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$624.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$312.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$138.54
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$173.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$55.17
|
|
|
CHROMOSOME COUNT 45C,2KW BANDI
|
Facility
|
OP
|
$1,064.30
|
|
|
Service Code
|
HCPCS 88263
|
| Hospital Charge Code |
38477213
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$542.50 |
| Rate for Payer: Aetna Commercial |
$408.79
|
| Rate for Payer: Aetna Medicare Advantage |
$486.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$542.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$542.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$150.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$542.50
|
| Rate for Payer: Cigna Commercial |
$532.15
|
| Rate for Payer: Cigna Medicare Advantage |
$150.29
|
| Rate for Payer: Clover Medicare Advantage |
$142.78
|
| Rate for Payer: EmblemHealth Commercial |
$450.87
|
| Rate for Payer: Humana Medicare Advantage |
$154.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$150.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$319.29
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$120.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$150.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$150.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.20
|
|
|
CHROMOSOME COUNT 45C,2KW BANDI
|
Facility
|
IP
|
$1,064.30
|
|
|
Service Code
|
HCPCS 88263
|
| Hospital Charge Code |
38477213
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$159.65 |
| Max. Negotiated Rate |
$159.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.65
|
|
|
CHROMOSOME IN SITU AMNIOTIC FL
|
Facility
|
IP
|
$1,177.90
|
|
|
Service Code
|
HCPCS 88269
|
| Hospital Charge Code |
38477214
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$176.69 |
| Max. Negotiated Rate |
$176.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.69
|
|
|
CHROMOSOME IN SITU AMNIOTIC FL
|
Facility
|
OP
|
$1,177.90
|
|
|
Service Code
|
HCPCS 88269
|
| Hospital Charge Code |
38477214
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$28.39 |
| Max. Negotiated Rate |
$626.86 |
| Rate for Payer: Aetna Commercial |
$472.36
|
| Rate for Payer: Aetna Medicare Advantage |
$562.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$626.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$626.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$173.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$626.86
|
| Rate for Payer: Cigna Commercial |
$588.95
|
| Rate for Payer: Cigna Medicare Advantage |
$173.66
|
| Rate for Payer: Clover Medicare Advantage |
$164.98
|
| Rate for Payer: EmblemHealth Commercial |
$520.98
|
| Rate for Payer: Humana Medicare Advantage |
$178.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$173.66
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$353.37
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$173.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.21
|
|
|
CHROMOSOME RFX TO MICROARRAY I
|
Facility
|
OP
|
$2,149.65
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
3038516B
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$1,074.83 |
| Rate for Payer: Aetna Commercial |
$341.33
|
| Rate for Payer: Aetna Medicare Advantage |
$406.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$452.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$452.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$452.98
|
| Rate for Payer: Cigna Commercial |
$1,074.83
|
| Rate for Payer: Cigna Medicare Advantage |
$125.49
|
| Rate for Payer: Clover Medicare Advantage |
$119.22
|
| Rate for Payer: EmblemHealth Commercial |
$376.47
|
| Rate for Payer: Humana Medicare Advantage |
$129.25
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$125.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$644.89
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$322.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$100.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$125.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.97
|
|
|
CHROMOSOME RFX TO MICROARRAY I
|
Facility
|
IP
|
$800.70
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
3038516A
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$120.11 |
| Max. Negotiated Rate |
$120.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.11
|
|
|
CHROMOSOME RFX TO MICROARRAY I
|
Facility
|
OP
|
$800.70
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
3038516A
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$420.49 |
| Rate for Payer: Aetna Commercial |
$316.85
|
| Rate for Payer: Aetna Medicare Advantage |
$377.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$420.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$420.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$116.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$420.49
|
| Rate for Payer: Cigna Commercial |
$400.35
|
| Rate for Payer: Cigna Medicare Advantage |
$116.49
|
| Rate for Payer: Clover Medicare Advantage |
$110.67
|
| Rate for Payer: EmblemHealth Commercial |
$349.47
|
| Rate for Payer: Humana Medicare Advantage |
$119.98
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$116.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.21
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$93.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$116.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$116.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.22
|
|
|
CHROMOSOME RFX TO MICROARRAY I
|
Facility
|
IP
|
$2,149.65
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
3038516B
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$322.45 |
| Max. Negotiated Rate |
$322.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$322.45
|
|
|
CHROMOSOMES, BLOOD I
|
Facility
|
OP
|
$800.70
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
39990122A
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$420.49 |
| Rate for Payer: Aetna Commercial |
$316.85
|
| Rate for Payer: Aetna Medicare Advantage |
$377.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$420.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$420.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$116.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$420.49
|
| Rate for Payer: Cigna Commercial |
$400.35
|
| Rate for Payer: Cigna Medicare Advantage |
$116.49
|
| Rate for Payer: Clover Medicare Advantage |
$110.67
|
| Rate for Payer: EmblemHealth Commercial |
$349.47
|
| Rate for Payer: Humana Medicare Advantage |
$119.98
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$116.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.21
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$93.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$116.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$116.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.22
|
|
|
CHROMOSOMES, BLOOD I
|
Facility
|
IP
|
$800.70
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
39990122A
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$120.11 |
| Max. Negotiated Rate |
$120.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.11
|
|
|
CHROMOSOMES, BLOOD II
|
Facility
|
OP
|
$856.65
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
39990122B
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$452.98 |
| Rate for Payer: Aetna Commercial |
$341.33
|
| Rate for Payer: Aetna Medicare Advantage |
$406.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$452.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$452.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$452.98
|
| Rate for Payer: Cigna Commercial |
$428.32
|
| Rate for Payer: Cigna Medicare Advantage |
$125.49
|
| Rate for Payer: Clover Medicare Advantage |
$119.22
|
| Rate for Payer: EmblemHealth Commercial |
$376.47
|
| Rate for Payer: Humana Medicare Advantage |
$129.25
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$125.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$257.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$100.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$125.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.70
|
|
|
CHROMOSOMES, BLOOD II
|
Facility
|
IP
|
$856.65
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
39990122B
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$128.50 |
| Max. Negotiated Rate |
$128.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.50
|
|
|
CHROMOSOMES,TISSUE I
|
Facility
|
IP
|
$967.20
|
|
|
Service Code
|
HCPCS 88233
|
| Hospital Charge Code |
39990123A
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$145.08 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.08
|
|
|
CHROMOSOMES,TISSUE I
|
Facility
|
OP
|
$967.20
|
|
|
Service Code
|
HCPCS 88233
|
| Hospital Charge Code |
39990123A
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$507.99 |
| Rate for Payer: Aetna Commercial |
$382.79
|
| Rate for Payer: Aetna Medicare Advantage |
$455.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$507.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$507.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$140.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$507.99
|
| Rate for Payer: Cigna Commercial |
$483.60
|
| Rate for Payer: Cigna Medicare Advantage |
$140.73
|
| Rate for Payer: Clover Medicare Advantage |
$133.69
|
| Rate for Payer: EmblemHealth Commercial |
$422.19
|
| Rate for Payer: Humana Medicare Advantage |
$144.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$140.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$290.16
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$112.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$140.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.63
|
|
|
CHROMOSOMES,TISSUE II
|
Facility
|
IP
|
$856.65
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
39990123B
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$128.50 |
| Max. Negotiated Rate |
$128.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.50
|
|
|
CHROMOSOMES,TISSUE II
|
Facility
|
OP
|
$856.65
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
39990123B
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$452.98 |
| Rate for Payer: Aetna Commercial |
$341.33
|
| Rate for Payer: Aetna Medicare Advantage |
$406.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$452.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$452.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$452.98
|
| Rate for Payer: Cigna Commercial |
$428.32
|
| Rate for Payer: Cigna Medicare Advantage |
$125.49
|
| Rate for Payer: Clover Medicare Advantage |
$119.22
|
| Rate for Payer: EmblemHealth Commercial |
$376.47
|
| Rate for Payer: Humana Medicare Advantage |
$129.25
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$125.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$257.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$100.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$125.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.70
|
|
|
CHROMOSOM RFX TO MICROARRAY IV
|
Facility
|
OP
|
$236.70
|
|
|
Service Code
|
HCPCS 88291
|
| Hospital Charge Code |
3038516D
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$89.95
|
| Rate for Payer: Aetna Medicare Advantage |
$71.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.36
|
| Rate for Payer: Cigna Commercial |
$118.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.01
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.27
|
|
