|
HISTOPLASMA ANTIGEN
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
38476250
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Medicare Advantage |
$38.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.24
|
| Rate for Payer: Cigna Commercial |
$78.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.98
|
| Rate for Payer: Clover Medicare Advantage |
$11.38
|
| Rate for Payer: EmblemHealth Commercial |
$35.94
|
| Rate for Payer: Humana Medicare Advantage |
$12.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.16
|
|
|
HISTOPLASMA ANTIGEN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
39900288
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HISTOPLASMA ANTIGEN
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
3035050
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
HISTOPLASMA ANTIGEN
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
38476250
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$23.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.55
|
|
|
HISTOPLASMA ANTIGEN
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
3035050
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$36.04
|
| Rate for Payer: Aetna Medicare Advantage |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.83
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.25
|
| Rate for Payer: Clover Medicare Advantage |
$12.59
|
| Rate for Payer: EmblemHealth Commercial |
$39.75
|
| Rate for Payer: Humana Medicare Advantage |
$13.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.31
|
|
|
HISTOPLASMA ANTIGEN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
39900288
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$36.04
|
| Rate for Payer: Aetna Medicare Advantage |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.83
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.25
|
| Rate for Payer: Clover Medicare Advantage |
$12.59
|
| Rate for Payer: EmblemHealth Commercial |
$39.75
|
| Rate for Payer: Humana Medicare Advantage |
$13.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.25
|
| 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 |
$10.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HISTO PLASMA ANTIGEN URINE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
3009991
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
HISTO PLASMA ANTIGEN URINE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
3009991
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$36.04
|
| Rate for Payer: Aetna Medicare Advantage |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.83
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.25
|
| Rate for Payer: Clover Medicare Advantage |
$12.59
|
| Rate for Payer: EmblemHealth Commercial |
$39.75
|
| Rate for Payer: Humana Medicare Advantage |
$13.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.31
|
|
|
HISTOPLASMOSIS, URINE***
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3031606
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$73.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.90
|
|
|
HISTOPLASMOSIS, URINE***
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3031606
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.05
|
|
|
HIV 1/2 AB
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
39900432
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HIV 1/2 AB
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
39900432
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$37.29
|
| Rate for Payer: Aetna Medicare Advantage |
$44.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.49
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.71
|
| Rate for Payer: Clover Medicare Advantage |
$13.02
|
| Rate for Payer: EmblemHealth Commercial |
$41.13
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.71
|
| 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 |
$10.97
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HIV1/2 AG&AB 4TH GEN W REFL-SO
|
Facility
|
OP
|
$118.90
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
401387389
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$65.50
|
| Rate for Payer: Aetna Medicare Advantage |
$78.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$26.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.92
|
| Rate for Payer: Cigna Commercial |
$59.45
|
| Rate for Payer: Cigna Medicare Advantage |
$24.08
|
| Rate for Payer: Clover Medicare Advantage |
$22.88
|
| Rate for Payer: EmblemHealth Commercial |
$72.24
|
| Rate for Payer: Humana Medicare Advantage |
$24.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.67
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.15
|
|
|
HIV1/2 AG&AB 4TH GEN W REFL-SO
|
Facility
|
IP
|
$118.90
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
401387389
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$17.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.84
|
|
|
HIV1/2 AG & AB 4TH GEN W REFLX
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
38479743
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$65.50
|
| Rate for Payer: Aetna Medicare Advantage |
$78.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$26.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.92
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.08
|
| Rate for Payer: Clover Medicare Advantage |
$22.88
|
| Rate for Payer: EmblemHealth Commercial |
$72.24
|
| Rate for Payer: Humana Medicare Advantage |
$24.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.08
|
| 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 |
$19.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
HIV1/2 AG & AB 4TH GEN W REFLX
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
38479743
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HIV-172 RAPID SCREEN
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
38479060
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$24.18
|
| Rate for Payer: Aetna Medicare Advantage |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.89
|
| 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 |
$32.09
|
| Rate for Payer: Cigna Commercial |
$261.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.89
|
| Rate for Payer: Clover Medicare Advantage |
$8.45
|
| Rate for Payer: EmblemHealth Commercial |
$26.67
|
| Rate for Payer: Humana Medicare Advantage |
$9.16
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.11
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.83
|
|
|
HIV-172 RAPID SCREEN
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
38479060
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.30
|
|
|
HIV-1AB,WB
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
38479090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$24.18
|
| Rate for Payer: Aetna Medicare Advantage |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.89
|
| 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 |
$32.09
|
| Rate for Payer: Cigna Commercial |
$261.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.89
|
| Rate for Payer: Clover Medicare Advantage |
$8.45
|
| Rate for Payer: EmblemHealth Commercial |
$26.67
|
| Rate for Payer: Humana Medicare Advantage |
$9.16
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.11
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.83
|
|
|
HIV-1AB,WB
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
38479090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.30
|
|
|
HIV 1 AB WESTERN BLOT
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
39900379
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$52.63
|
| Rate for Payer: Aetna Medicare Advantage |
$62.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$69.85
|
| Rate for Payer: Cigna Commercial |
$66.50
|
| Rate for Payer: Cigna Medicare Advantage |
$19.35
|
| Rate for Payer: Clover Medicare Advantage |
$18.38
|
| Rate for Payer: EmblemHealth Commercial |
$58.05
|
| Rate for Payer: Humana Medicare Advantage |
$19.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.52
|
|
|
HIV 1 AB WESTERN BLOT
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
39900379
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.95
|
|
|
HIV-1 AB W/FX
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
38479089
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$24.18
|
| Rate for Payer: Aetna Medicare Advantage |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.89
|
| 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 |
$32.09
|
| Rate for Payer: Cigna Commercial |
$261.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.89
|
| Rate for Payer: Clover Medicare Advantage |
$8.45
|
| Rate for Payer: EmblemHealth Commercial |
$26.67
|
| Rate for Payer: Humana Medicare Advantage |
$9.16
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.11
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.83
|
|
|
HIV-1 AB W/FX
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
38479089
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.30
|
|
|
HIV-1 DNA,PCR
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS 87535
|
| Hospital Charge Code |
38476238
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$250.50 |
| 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 |
$38.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$250.50
|
| 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 |
$150.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.15
|
| 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 |
$13.28
|
|
