|
CMV AB (IGM)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
39900232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CMV CONVENT., RAPID CULT 1
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
3990162A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$94.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$94.10
|
| 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 |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$94.10
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| 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 |
$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 |
$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 |
$10.34
|
|
|
CMV CONVENT., RAPID CULT 1
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
3990162A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CMV CONVENT., RAPID CULT 11
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
3990162B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$53.20
|
| Rate for Payer: Aetna Medicare Advantage |
$63.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.61
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$19.56
|
| Rate for Payer: Clover Medicare Advantage |
$18.58
|
| Rate for Payer: EmblemHealth Commercial |
$58.68
|
| Rate for Payer: Humana Medicare Advantage |
$20.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.56
|
| 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 |
$15.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
CMV CONVENT., RAPID CULT 11
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
3990162B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CMV DNA,PCR
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
38475108
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$88.50
|
|
|
CMV DNA,PCR
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
38475108
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$295.00 |
| 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 |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.66
|
| 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 |
$153.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$295.00
|
| 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 |
$177.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$88.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| 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 |
$15.63
|
|
|
CMV DNA Q1 REAL TIME PCR
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
39900293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CMV DNA Q1 REAL TIME PCR
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
39900293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.34 |
| 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 |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.66
|
| 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 |
$153.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| 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 |
$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 |
$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 |
$10.34
|
|
|
CMV DNA QL REAL TIME PCR
|
Facility
|
OP
|
$281.65
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
3035055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$153.02 |
| 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 |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.66
|
| 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 |
$153.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$140.82
|
| 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 |
$84.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| 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 |
$7.46
|
|
|
CMV DNA QL REAL TIME PCR
|
Facility
|
IP
|
$281.65
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
3035055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.25
|
|
|
CMV DNA,QN,REAL-TIME PCR
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
39900295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CMV DNA,QN,REAL-TIME PCR
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
39900295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$195.00
|
| 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 |
$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 |
$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 |
$10.34
|
|
|
CMV DNA QT REAL TIME PCR
|
Facility
|
IP
|
$281.65
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
3035058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.25
|
|
|
CMV DNA QT REAL TIME PCR
|
Facility
|
OP
|
$281.65
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
3035058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$153.02 |
| 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 |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.66
|
| 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 |
$153.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$140.82
|
| 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 |
$84.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| 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 |
$7.46
|
|
|
CMV DNA ULTRAQUANT
|
Facility
|
OP
|
$294.40
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
39900294
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$154.64 |
| 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 |
$147.20
|
| 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 |
$88.32
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.16
|
| 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 |
$7.80
|
|
|
CMV DNA ULTRAQUANT
|
Facility
|
IP
|
$294.40
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
39900294
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.16
|
|
|
CMV IgG BY EIA
|
Facility
|
OP
|
$188.85
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
3006582
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.94
|
| 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 |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.94
|
| Rate for Payer: Cigna Commercial |
$94.42
|
| 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 |
$56.66
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| 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 |
$5.00
|
|
|
CMV IgG BY EIA
|
Facility
|
IP
|
$188.85
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
3006582
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$28.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.33
|
|
|
CMV IGG/IGM, CSF I
|
Facility
|
OP
|
$188.85
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
3038100A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.94
|
| 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 |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.94
|
| Rate for Payer: Cigna Commercial |
$94.42
|
| 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 |
$56.66
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| 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 |
$5.00
|
|
|
CMV IGG/IGM, CSF I
|
Facility
|
IP
|
$188.85
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
3038100A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$28.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.33
|
|
|
CMV IGG/IGM, CSF II
|
Facility
|
OP
|
$157.45
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
3038100B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.17 |
| 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 |
$78.72
|
| 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 |
$47.23
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.62
|
| 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 |
$4.17
|
|
|
CMV IGG/IGM, CSF II
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
3038100B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.62
|
|
|
CMV IGG/IGM I
|
Facility
|
IP
|
$98.95
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
39990091A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$14.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.84
|
|
|
CMV IGG/IGM I
|
Facility
|
OP
|
$98.95
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
39990091A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.94
|
| 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 |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.94
|
| Rate for Payer: Cigna Commercial |
$49.48
|
| 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 |
$29.68
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| 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 |
$2.62
|
|
