|
HEPATITIS INJ 10MCG/0.05ML
|
Facility
|
OP
|
$171.79
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
60628287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$85.89 |
| Rate for Payer: Aetna Commercial |
$65.28
|
| Rate for Payer: Aetna Medicare Advantage |
$51.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$63.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.81
|
| Rate for Payer: Cigna Commercial |
$85.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.77
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.55
|
|
|
HEPATITIS INJ 10MCG/0.05ML
|
Facility
|
IP
|
$171.79
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
60628287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$41.57 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.77
|
|
|
HEPATITIS INJ 20MCG/1ML
|
Facility
|
OP
|
$955.15
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
60629109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.02 |
| Max. Negotiated Rate |
$506.12 |
| Rate for Payer: Aetna Commercial |
$381.37
|
| Rate for Payer: Aetna Medicare Advantage |
$454.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$506.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$506.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$140.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$148.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$506.12
|
| Rate for Payer: Cigna Medicare Advantage |
$140.21
|
| Rate for Payer: Clover Medicare Advantage |
$133.20
|
| Rate for Payer: EmblemHealth Commercial |
$420.63
|
| Rate for Payer: Humana Medicare Advantage |
$144.42
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$140.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$231.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$143.27
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$140.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.31
|
|
|
HEPATITIS INJ 20MCG/1ML
|
Facility
|
IP
|
$955.15
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
60629109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.27 |
| Max. Negotiated Rate |
$231.15 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$231.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$143.27
|
|
|
HEPATITIS PANEL
|
Facility
|
IP
|
$37.50
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
39900420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.62
|
|
|
HEPATITIS PANEL
|
Facility
|
OP
|
$37.50
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
39900420
|
|
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 PANEL-SO
|
Facility
|
IP
|
$551.86
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
401380074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.78 |
| Max. Negotiated Rate |
$82.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.78
|
|
|
HEPATITIS PANEL-SO
|
Facility
|
OP
|
$551.86
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
401380074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$275.93 |
| 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 |
$275.93
|
| 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 |
$165.56
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.78
|
| 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 |
$14.62
|
|
|
HEPATITIS PROF.
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
38479101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$194.55 |
| Max. Negotiated Rate |
$194.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.55
|
|
|
HEPATITIS PROF.
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
38479101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.37 |
| Max. Negotiated Rate |
$648.50 |
| 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 |
$648.50
|
| 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 |
$389.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.55
|
| 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 |
$34.37
|
|
|
HEPATITIS PROFILE
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
38472330
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$194.55 |
| Max. Negotiated Rate |
$194.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.55
|
|
|
HEPATITIS PROFILE
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
38472330
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.37 |
| Max. Negotiated Rate |
$648.50 |
| 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 |
$648.50
|
| 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 |
$389.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.55
|
| 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 |
$34.37
|
|
|
HEPATITS A VIRUS
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
38479443
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.90
|
|
|
HEPATITS A VIRUS
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
38479443
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Medicare Advantage |
$40.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.72
|
| Rate for Payer: Cigna Commercial |
$213.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.39
|
| Rate for Payer: Clover Medicare Advantage |
$11.77
|
| Rate for Payer: EmblemHealth Commercial |
$37.17
|
| Rate for Payer: Humana Medicare Advantage |
$12.76
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.29
|
|
|
HEPATITS B SURFACE AB QUA
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
39900211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$40.77
|
| Rate for Payer: Aetna Medicare Advantage |
$48.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.11
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.99
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.99
|
| 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 |
$11.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEPATITS B SURFACE AB QUA
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
39900211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITS B VIRUS DNA QUANT PCR
|
Facility
|
OP
|
$2,190.80
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
3038539
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$1,095.40 |
| 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 |
$1,095.40
|
| 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 |
$657.24
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.62
|
| 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 |
$58.06
|
|
|
HEPATITS B VIRUS DNA QUANT PCR
|
Facility
|
IP
|
$2,190.80
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
3038539
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$328.62 |
| Max. Negotiated Rate |
$328.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.62
|
|
|
HEPATITS PANEL NON-ACUTE I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
39990133A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare Advantage |
$39.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.50
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.45
|
| Rate for Payer: EmblemHealth Commercial |
$36.15
|
| Rate for Payer: Humana Medicare Advantage |
$12.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.05
|
| 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 |
$9.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEPATITS PANEL NON-ACUTE I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
39990133A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITS PANEL NON-ACUTE II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
39990133B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$29.21
|
| Rate for Payer: Aetna Medicare Advantage |
$34.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.77
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.74
|
| Rate for Payer: Clover Medicare Advantage |
$10.20
|
| Rate for Payer: EmblemHealth Commercial |
$32.22
|
| Rate for Payer: Humana Medicare Advantage |
$11.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.74
|
| 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 |
$8.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEPATITS PANEL NON-ACUTE II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
39990133B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITS PANEL NON-ACUTE III
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
39990133C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITS PANEL NON-ACUTE III
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
39990133C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$38.81
|
| Rate for Payer: Aetna Medicare Advantage |
$46.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.51
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.27
|
| Rate for Payer: Clover Medicare Advantage |
$13.56
|
| Rate for Payer: EmblemHealth Commercial |
$42.81
|
| Rate for Payer: Humana Medicare Advantage |
$14.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.27
|
| 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 |
$11.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEPATITS PANEL NON-ACUTE IV
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
39990133D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
