|
HCV FIBROSURE II
|
Facility
|
OP
|
$47.25
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
3036014B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare Advantage |
$17.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.13
|
| Rate for Payer: Cigna Commercial |
$23.62
|
| Rate for Payer: Cigna Medicare Advantage |
$5.30
|
| Rate for Payer: Clover Medicare Advantage |
$5.04
|
| Rate for Payer: EmblemHealth Commercial |
$15.90
|
| Rate for Payer: Humana Medicare Advantage |
$5.46
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.18
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.25
|
|
|
HCV FIBROSURE II
|
Facility
|
IP
|
$47.25
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
3036014B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.09
|
|
|
HCV FIBROSURE III
|
Facility
|
IP
|
$205.65
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
3036014C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$30.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.85
|
|
|
HCV FIBROSURE III
|
Facility
|
OP
|
$205.65
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
3036014C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$57.36
|
| Rate for Payer: Aetna Medicare Advantage |
$68.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.13
|
| Rate for Payer: Cigna Commercial |
$102.83
|
| Rate for Payer: Cigna Medicare Advantage |
$21.09
|
| Rate for Payer: Clover Medicare Advantage |
$20.04
|
| Rate for Payer: EmblemHealth Commercial |
$63.27
|
| Rate for Payer: Humana Medicare Advantage |
$21.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.45
|
|
|
HCV FIBROSURE IV
|
Facility
|
IP
|
$54.45
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3036014D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$8.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
|
|
HCV FIBROSURE IV
|
Facility
|
OP
|
$54.45
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3036014D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.02
|
| 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 |
$18.12
|
| Rate for Payer: Cigna Commercial |
$27.23
|
| Rate for Payer: Cigna Medicare Advantage |
$5.02
|
| Rate for Payer: Clover Medicare Advantage |
$4.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.34
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.44
|
|
|
HCV FIBROSURE V
|
Facility
|
IP
|
$65.65
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
3036014E
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
HCV FIBROSURE V
|
Facility
|
OP
|
$65.65
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
3036014E
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Medicare Advantage |
$23.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.20
|
| 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 |
$25.99
|
| Rate for Payer: Cigna Commercial |
$32.83
|
| Rate for Payer: Cigna Medicare Advantage |
$7.20
|
| Rate for Payer: Clover Medicare Advantage |
$6.84
|
| Rate for Payer: EmblemHealth Commercial |
$21.60
|
| Rate for Payer: Humana Medicare Advantage |
$7.42
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.74
|
|
|
HCV FIBROSURE VI
|
Facility
|
IP
|
$119.25
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
3036014F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.89
|
|
|
HCV FIBROSURE VI
|
Facility
|
OP
|
$119.25
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
3036014F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$34.22
|
| Rate for Payer: Aetna Medicare Advantage |
$40.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.58
|
| 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 |
$45.41
|
| Rate for Payer: Cigna Commercial |
$59.62
|
| Rate for Payer: Cigna Medicare Advantage |
$12.58
|
| Rate for Payer: Clover Medicare Advantage |
$11.95
|
| Rate for Payer: EmblemHealth Commercial |
$37.74
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.77
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.16
|
|
|
HCV GENOTYPE, LIPA
|
Facility
|
IP
|
$1,769.40
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
39900308
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$265.41 |
| Max. Negotiated Rate |
$265.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$265.41
|
|
|
HCV GENOTYPE, LIPA
|
Facility
|
OP
|
$1,769.40
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
39900308
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.89 |
| 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 |
$884.70
|
| 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 |
$530.82
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$265.41
|
| 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 |
$46.89
|
|
|
HCV RNA GENOTYPE
|
Facility
|
OP
|
$1,823.20
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
38473153
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.31 |
| 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 |
$911.60
|
| 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 |
$546.96
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.48
|
| 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 |
$48.31
|
|
|
HCV RNA GENOTYPE
|
Facility
|
IP
|
$1,823.20
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
38473153
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$273.48 |
| Max. Negotiated Rate |
$273.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.48
|
|
|
HCV RNA,PCR
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
39900300
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$236.19 |
| 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 |
$236.19
|
| 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
|
|
|
HCV RNA,PCR
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
39900300
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HCV RNA,QL,PCR
|
Facility
|
IP
|
$383.25
|
|
|
Service Code
|
HCPCS 87521
|
| Hospital Charge Code |
3009390
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$57.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.49
|
|
|
HCV RNA,QL,PCR
|
Facility
|
OP
|
$383.25
|
|
|
Service Code
|
HCPCS 87521
|
| Hospital Charge Code |
3009390
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$191.62 |
| 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 |
$73.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$191.62
|
| 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 |
$114.97
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.49
|
| 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 |
$10.16
|
|
|
HCV RNA,QL,PCR,PLASMA
|
Facility
|
OP
|
$241.20
|
|
|
Service Code
|
HCPCS 87521
|
| Hospital Charge Code |
39900299
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$126.66 |
| 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 |
$73.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$120.60
|
| 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 |
$72.36
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.18
|
| 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 |
$6.39
|
|
|
HCV RNA,QL,PCR,PLASMA
|
Facility
|
IP
|
$241.20
|
|
|
Service Code
|
HCPCS 87521
|
| Hospital Charge Code |
39900299
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.18 |
| Max. Negotiated Rate |
$36.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.18
|
|
|
HCV RNA,QN,REAL TIME PCR
|
Facility
|
IP
|
$383.25
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
3009389
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$57.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.49
|
|
|
HCV RNA,QN,REAL TIME PCR
|
Facility
|
OP
|
$383.25
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
3009389
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$236.19 |
| 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 |
$236.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.64
|
| Rate for Payer: Cigna Commercial |
$191.62
|
| 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 |
$114.97
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.49
|
| 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 |
$10.16
|
|
|
HCV VRNA GENOTYP 1NS5bRXRESIST
|
Facility
|
OP
|
$776.05
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
401187902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.57 |
| 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 |
$388.02
|
| 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 |
$232.81
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.41
|
| 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 |
$20.57
|
|
|
HCV VRNA GENOTYP 1NS5bRXRESIST
|
Facility
|
IP
|
$776.05
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
401187902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$116.41 |
| Max. Negotiated Rate |
$116.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.41
|
|
|
HD 5 US BAGLESS
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
270703400
|
|
Hospital Revenue Code
|
278
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
