|
HEPATITS PANEL NON-ACUTE IV
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
39990133D
|
|
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 V
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
39990133E
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITS PANEL NON-ACUTE V
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
39990133E
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$28.10
|
| Rate for Payer: Aetna Medicare Advantage |
$33.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.29
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.33
|
| Rate for Payer: Clover Medicare Advantage |
$9.81
|
| Rate for Payer: EmblemHealth Commercial |
$30.99
|
| Rate for Payer: Humana Medicare Advantage |
$10.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.33
|
| 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 |
$8.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC
|
Facility
|
IP
|
$58,292.96
|
|
|
Service Code
|
MSDRG 421
|
| Min. Negotiated Rate |
$17,749.46 |
| Max. Negotiated Rate |
$58,292.96 |
| Rate for Payer: Aetna Commercial |
$40,311.23
|
| Rate for Payer: Aetna Medicare Advantage |
$58,292.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39,776.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39,776.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18,683.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39,776.31
|
| Rate for Payer: Cigna Commercial |
$32,515.58
|
| Rate for Payer: Cigna Medicare Advantage |
$18,683.64
|
| Rate for Payer: Clover Medicare Advantage |
$17,749.46
|
| Rate for Payer: EmblemHealth Commercial |
$56,050.92
|
| Rate for Payer: Humana Medicare Advantage |
$19,244.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18,683.64
|
| Rate for Payer: Oxford Commercial |
$23,369.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$40,978.94
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18,683.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$18,683.64
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$112,257.19
|
|
|
Service Code
|
MSDRG 420
|
| Min. Negotiated Rate |
$34,180.88 |
| Max. Negotiated Rate |
$112,257.19 |
| Rate for Payer: Aetna Commercial |
$77,390.81
|
| Rate for Payer: Aetna Medicare Advantage |
$112,257.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$74,435.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$74,435.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35,979.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$74,435.20
|
| Rate for Payer: Cigna Commercial |
$63,760.47
|
| Rate for Payer: Cigna Medicare Advantage |
$35,979.87
|
| Rate for Payer: Clover Medicare Advantage |
$34,180.88
|
| Rate for Payer: EmblemHealth Commercial |
$107,939.61
|
| Rate for Payer: Humana Medicare Advantage |
$37,059.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35,979.87
|
| Rate for Payer: Oxford Commercial |
$45,825.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$80,356.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35,979.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$35,979.87
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$47,368.25
|
|
|
Service Code
|
MSDRG 422
|
| Min. Negotiated Rate |
$14,423.02 |
| Max. Negotiated Rate |
$47,368.25 |
| Rate for Payer: Aetna Commercial |
$32,804.70
|
| Rate for Payer: Aetna Medicare Advantage |
$47,368.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32,798.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32,798.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15,182.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32,798.01
|
| Rate for Payer: Cigna Commercial |
$26,190.24
|
| Rate for Payer: Cigna Medicare Advantage |
$15,182.13
|
| Rate for Payer: Clover Medicare Advantage |
$14,423.02
|
| Rate for Payer: EmblemHealth Commercial |
$45,546.39
|
| Rate for Payer: Humana Medicare Advantage |
$15,637.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15,182.13
|
| Rate for Payer: Oxford Commercial |
$18,823.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$33,007.21
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15,182.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$15,182.13
|
|
|
HEPATOLITE
|
Facility
|
IP
|
$62.75
|
|
| Hospital Charge Code |
270658220
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.41
|
|
|
HEPATOLITE
|
Facility
|
OP
|
$62.75
|
|
| Hospital Charge Code |
270658220
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$31.38 |
| Rate for Payer: Aetna Commercial |
$23.84
|
| Rate for Payer: Aetna Medicare Advantage |
$18.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.00
|
| Rate for Payer: Cigna Commercial |
$31.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.82
|
| Rate for Payer: Oxford Commercial |
$12.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.66
|
|
|
HEP A VIRUS ANT IGG
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
38479435
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.90
|
|
|
HEP A VIRUS ANT IGG
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
38479435
|
|
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
|
|
|
HEP B CORE ANTIB
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
38479493
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
|
|
HEP B CORE ANTIB
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
38479493
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$31.36
|
| Rate for Payer: Aetna Medicare Advantage |
$37.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.62
|
| Rate for Payer: Cigna Commercial |
$279.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.53
|
| Rate for Payer: Clover Medicare Advantage |
$10.95
|
| Rate for Payer: EmblemHealth Commercial |
$34.59
|
| Rate for Payer: Humana Medicare Advantage |
$11.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$167.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.81
|
|
|
HEP BE ANTIG
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
38479486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
|
|
HEP BE ANTIG
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
38479486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$31.47
|
| Rate for Payer: Aetna Medicare Advantage |
$37.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.76
|
| Rate for Payer: Cigna Commercial |
$279.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.57
|
| Rate for Payer: Clover Medicare Advantage |
$10.99
|
| Rate for Payer: EmblemHealth Commercial |
$34.71
|
| Rate for Payer: Humana Medicare Advantage |
$11.92
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$167.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.81
|
|
|
HEP BE ANTIGENT
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
38479487
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$287.00 |
| 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 |
$287.00
|
| 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 |
$172.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.10
|
| 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 |
$15.21
|
|
|
HEP BE ANTIGENT
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
38479487
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.10
|
|
|
HEP B IMMUNE GLOB. 5 ML
|
Facility
|
IP
|
$3,089.00
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
60635745
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$463.35 |
| Max. Negotiated Rate |
$747.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$747.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$463.35
|
|
|
HEP B IMMUNE GLOB. 5 ML
|
Facility
|
OP
|
$3,089.00
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
60635745
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.44 |
| Max. Negotiated Rate |
$747.54 |
| 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 |
$747.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$463.35
|
| Rate for Payer: UnitedHealthcare Community & State |
$74.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$140.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$81.86
|
|
|
HEP B IMMUNE GLOB. .5ML
|
Facility
|
OP
|
$367.60
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
60635746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.86 |
| 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 |
$88.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.14
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$140.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.74
|
|
|
HEP B IMMUNE GLOB. .5ML
|
Facility
|
IP
|
$367.60
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
60635746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.14 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.14
|
|
|
HEP B SURF
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
38479485
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
|
|
HEP B SURF
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
38479485
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$279.50 |
| 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 |
$279.50
|
| 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 |
$167.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
| 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 |
$14.81
|
|
|
HEP B SURF AB QNT
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
38479494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$279.50 |
| 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 |
$279.50
|
| 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 |
$167.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
| 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 |
$14.81
|
|
|
HEP B SURF AB QNT
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
38479494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
|
|
HEP B SURFACE AB QN
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
38479104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
|
