|
HEPATITIS D AB,TOTAL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86692
|
| Hospital Charge Code |
39900240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$46.68
|
| Rate for Payer: Aetna Medicare Advantage |
$55.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.16
|
| 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 |
$61.94
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.16
|
| Rate for Payer: Clover Medicare Advantage |
$16.30
|
| Rate for Payer: EmblemHealth Commercial |
$51.48
|
| Rate for Payer: Humana Medicare Advantage |
$17.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.16
|
| 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 |
$13.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEPATITIS DELTA ANTIBODY
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 86692
|
| Hospital Charge Code |
38472362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.68
|
| Rate for Payer: Aetna Medicare Advantage |
$55.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.16
|
| 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 |
$61.94
|
| Rate for Payer: Cigna Commercial |
$68.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.16
|
| Rate for Payer: Clover Medicare Advantage |
$16.30
|
| Rate for Payer: EmblemHealth Commercial |
$51.48
|
| Rate for Payer: Humana Medicare Advantage |
$17.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.63
|
|
|
HEPATITIS DELTA ANTIBODY
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 86692
|
| Hospital Charge Code |
38472362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$20.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.55
|
|
|
HEPATITIS D VIRUS IGM AB EIA
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86692
|
| Hospital Charge Code |
401086692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITIS D VIRUS IGM AB EIA
|
Facility
|
IP
|
$268.84
|
|
|
Service Code
|
HCPCS 86692
|
| Hospital Charge Code |
401386692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.33 |
| Max. Negotiated Rate |
$40.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.33
|
|
|
HEPATITIS D VIRUS IGM AB EIA
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86692
|
| Hospital Charge Code |
401086692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$46.68
|
| Rate for Payer: Aetna Medicare Advantage |
$55.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.16
|
| 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 |
$61.94
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.16
|
| Rate for Payer: Clover Medicare Advantage |
$16.30
|
| Rate for Payer: EmblemHealth Commercial |
$51.48
|
| Rate for Payer: Humana Medicare Advantage |
$17.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.16
|
| 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 |
$13.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEPATITIS D VIRUS IGM AB EIA
|
Facility
|
OP
|
$268.84
|
|
|
Service Code
|
HCPCS 86692
|
| Hospital Charge Code |
401386692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$134.42 |
| Rate for Payer: Aetna Commercial |
$46.68
|
| Rate for Payer: Aetna Medicare Advantage |
$55.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.16
|
| 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 |
$61.94
|
| Rate for Payer: Cigna Commercial |
$134.42
|
| Rate for Payer: Cigna Medicare Advantage |
$17.16
|
| Rate for Payer: Clover Medicare Advantage |
$16.30
|
| Rate for Payer: EmblemHealth Commercial |
$51.48
|
| Rate for Payer: Humana Medicare Advantage |
$17.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.65
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.12
|
|
|
HEPATITIS D VIRUS RNA, Q.L.
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
3035155
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.89 |
| 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 |
$130.00
|
| 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 |
$78.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
| 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 |
$6.89
|
|
|
HEPATITIS D VIRUS RNA, Q.L.
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
3035155
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
|
|
HEPATITIS E AB (IGM)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
39900390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITIS E AB (IGM)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
39900390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$459.20 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$459.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| 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 |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEPATITIS E,IGE
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38476272
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$459.20 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$459.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.21
|
|
|
HEPATITIS E,IGE
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38476272
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.80
|
|
|
HEPATITIS E IGG
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
39900389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITIS E IGG
|
Facility
|
OP
|
$93.65
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3038124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$459.20 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$459.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$46.83
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.09
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.48
|
|
|
HEPATITIS E IGG
|
Facility
|
IP
|
$93.65
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3038124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
|
|
HEPATITIS E IGG
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
39900389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$459.20 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$459.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| 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 |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEPATITIS E IGM
|
Facility
|
IP
|
$93.65
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3038123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
|
|
HEPATITIS E IGM
|
Facility
|
OP
|
$93.65
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3038123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$459.20 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$459.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.49
|
| Rate for Payer: Cigna Commercial |
$46.83
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.09
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.48
|
|
|
HEPATITIS FUNCTION PROFILE
|
Facility
|
IP
|
$37.50
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
3004843A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.62
|
|
|
HEPATITIS FUNCTION PROFILE
|
Facility
|
OP
|
$37.50
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
3004843A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$171.93 |
| Rate for Payer: Aetna Commercial |
$129.55
|
| Rate for Payer: Aetna Medicare Advantage |
$154.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$171.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$171.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$63.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$171.93
|
| Rate for Payer: Cigna Commercial |
$18.75
|
| Rate for Payer: Cigna Medicare Advantage |
$47.63
|
| Rate for Payer: Clover Medicare Advantage |
$45.25
|
| Rate for Payer: EmblemHealth Commercial |
$142.89
|
| Rate for Payer: Humana Medicare Advantage |
$49.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$47.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.25
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$47.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.99
|
|
|
HEPATITIS FUNCTION PROFILE
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
3004843
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.00
|
|
|
HEPATITIS FUNCTION PROFILE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
3004842A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$171.93 |
| Rate for Payer: Aetna Commercial |
$129.55
|
| Rate for Payer: Aetna Medicare Advantage |
$154.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$171.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$171.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$63.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$171.93
|
| Rate for Payer: Cigna Commercial |
$15.00
|
| Rate for Payer: Cigna Medicare Advantage |
$47.63
|
| Rate for Payer: Clover Medicare Advantage |
$45.25
|
| Rate for Payer: EmblemHealth Commercial |
$142.89
|
| Rate for Payer: Humana Medicare Advantage |
$49.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$47.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$47.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.80
|
|
|
HEPATITIS FUNCTION PROFILE
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
3004842A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
|
|
HEPATITIS FUNCTION PROFILE
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
3004843
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna Commercial |
$220.40
|
| Rate for Payer: Aetna Medicare Advantage |
$174.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$147.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$147.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$147.90
|
| Rate for Payer: Cigna Commercial |
$290.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.37
|
|
