|
IMMUNOASSAY PLUS TRILEVEL
|
Facility
|
OP
|
$589.80
|
|
| Hospital Charge Code |
270653738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$294.90 |
| Rate for Payer: Aetna Commercial |
$224.12
|
| Rate for Payer: Aetna Medicare Advantage |
$176.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$150.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$150.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$150.40
|
| Rate for Payer: Cigna Commercial |
$294.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$176.94
|
| Rate for Payer: Oxford Commercial |
$117.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$88.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$117.96
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.63
|
|
|
IMMUNOASSAY PROTEIN CA 125
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
401086304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare Advantage |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.12
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.81
|
| Rate for Payer: Clover Medicare Advantage |
$19.77
|
| Rate for Payer: EmblemHealth Commercial |
$62.43
|
| Rate for Payer: Humana Medicare Advantage |
$21.43
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.81
|
| 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 |
$16.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
IMMUNOASSAY PROTEIN CA 125
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
401086304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
IMMUNOASSAY QUANT BY RIA
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
38478083
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$24.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.90
|
|
|
IMMUNOASSAY QUANT BY RIA
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
38478083
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Aetna Medicare Advantage |
$59.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.42
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.40
|
| Rate for Payer: Clover Medicare Advantage |
$17.48
|
| Rate for Payer: EmblemHealth Commercial |
$55.20
|
| Rate for Payer: Humana Medicare Advantage |
$18.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.40
|
|
|
IMMUNOASSAY QUANTITATIVE NOS
|
Facility
|
IP
|
$91.70
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
38478108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$13.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.76
|
|
|
IMMUNOASSAY QUANTITATIVE NOS
|
Facility
|
OP
|
$91.70
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
38478108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.43 |
| 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 |
$45.85
|
| 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 |
$27.51
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.76
|
| 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 |
$2.43
|
|
|
IMMUNOASSAY TUMOR ANTIGEN
|
Facility
|
IP
|
$115.74
|
|
|
Service Code
|
HCPCS 86294
|
| Hospital Charge Code |
38477136
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.36
|
|
|
IMMUNOASSAY TUMOR ANTIGEN
|
Facility
|
OP
|
$115.74
|
|
|
Service Code
|
HCPCS 86294
|
| Hospital Charge Code |
38477136
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$69.55
|
| Rate for Payer: Aetna Medicare Advantage |
$82.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$25.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.30
|
| Rate for Payer: Cigna Commercial |
$57.87
|
| Rate for Payer: Cigna Medicare Advantage |
$25.57
|
| Rate for Payer: Clover Medicare Advantage |
$24.29
|
| Rate for Payer: EmblemHealth Commercial |
$76.71
|
| Rate for Payer: Humana Medicare Advantage |
$26.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$25.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.72
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.46
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$25.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.07
|
|
|
IMMUNO COMPLEX DETECTION BY C1
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86332
|
| Hospital Charge Code |
39900438
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$66.29
|
| Rate for Payer: Aetna Medicare Advantage |
$78.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.37
|
| 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 |
$87.97
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.37
|
| Rate for Payer: Clover Medicare Advantage |
$23.15
|
| Rate for Payer: EmblemHealth Commercial |
$73.11
|
| Rate for Payer: Humana Medicare Advantage |
$25.10
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.37
|
| 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 |
$19.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
IMMUNO COMPLEX DETECTION BY C1
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86332
|
| Hospital Charge Code |
39900438
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
IMMUNOCYTOCHEMISTRY STAIN 1ST
|
Facility
|
IP
|
$1,082.30
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
3005338
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$162.34 |
| Max. Negotiated Rate |
$162.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.34
|
|
|
IMMUNOCYTOCHEMISTRY STAIN 1ST
|
Facility
|
OP
|
$1,082.30
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
3005338
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$730.60 |
| Rate for Payer: Aetna Commercial |
$550.53
|
| Rate for Payer: Aetna Medicare Advantage |
$655.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$730.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$730.60
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$202.40
|
| Rate for Payer: Clover Medicare Advantage |
$192.28
|
| Rate for Payer: EmblemHealth Commercial |
$607.20
|
| Rate for Payer: Humana Medicare Advantage |
$208.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$202.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$324.69
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$86.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.68
|
|
|
IMMUNOELECTROPHORESIS, CSF
|
Facility
|
IP
|
$198.45
|
|
|
Service Code
|
HCPCS 86325
|
| Hospital Charge Code |
3001013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$29.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.77
|
|
|
IMMUNOELECTROPHORESIS, CSF
|
Facility
|
OP
|
$198.45
|
|
|
Service Code
|
HCPCS 86325
|
| Hospital Charge Code |
3001013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$62.91
|
| Rate for Payer: Aetna Medicare Advantage |
$74.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$23.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$83.49
|
| Rate for Payer: Cigna Commercial |
$99.22
|
| Rate for Payer: Cigna Medicare Advantage |
$23.13
|
| Rate for Payer: Clover Medicare Advantage |
$21.97
|
| Rate for Payer: EmblemHealth Commercial |
$69.39
|
| Rate for Payer: Humana Medicare Advantage |
$23.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$23.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.53
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$23.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.26
|
|
|
IMMUNOFIX AND PROTIN ELECTRO C
|
Facility
|
IP
|
$226.45
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
3038077C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.97
|
|
|
IMMUNOFIX AND PROTIN ELECTRO C
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
3038077B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
|
|
IMMUNOFIX AND PROTIN ELECTRO C
|
Facility
|
OP
|
$68.75
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
3038077A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$15,880.57 |
| Rate for Payer: Aetna Commercial |
$10.88
|
| Rate for Payer: Aetna Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.44
|
| Rate for Payer: Cigna Commercial |
$34.38
|
| Rate for Payer: Cigna Medicare Advantage |
$4.00
|
| Rate for Payer: Clover Medicare Advantage |
$3.80
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Humana Medicare Advantage |
$4.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.62
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$15,880.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.82
|
|
|
IMMUNOFIX AND PROTIN ELECTRO C
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
3038077B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.50
|
| Rate for Payer: Aetna Medicare Advantage |
$57.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.36
|
| Rate for Payer: Cigna Commercial |
$55.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.83
|
| Rate for Payer: Clover Medicare Advantage |
$16.94
|
| Rate for Payer: EmblemHealth Commercial |
$53.49
|
| Rate for Payer: Humana Medicare Advantage |
$18.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.92
|
|
|
IMMUNOFIX AND PROTIN ELECTRO C
|
Facility
|
IP
|
$68.75
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
3038077A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.31
|
|
|
IMMUNOFIX AND PROTIN ELECTRO C
|
Facility
|
OP
|
$226.45
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
3038077C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$79.83
|
| Rate for Payer: Aetna Medicare Advantage |
$95.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$63.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.94
|
| Rate for Payer: Cigna Commercial |
$113.22
|
| Rate for Payer: Cigna Medicare Advantage |
$29.35
|
| Rate for Payer: Clover Medicare Advantage |
$27.88
|
| Rate for Payer: EmblemHealth Commercial |
$88.05
|
| Rate for Payer: Humana Medicare Advantage |
$30.23
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$29.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.94
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.00
|
|
|
IMMUNOFIXATION CSF
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
3001627A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
|
|
IMMUNOFIXATION CSF
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
3001627A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.50
|
| Rate for Payer: Aetna Medicare Advantage |
$57.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.36
|
| Rate for Payer: Cigna Commercial |
$55.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.83
|
| Rate for Payer: Clover Medicare Advantage |
$16.94
|
| Rate for Payer: EmblemHealth Commercial |
$53.49
|
| Rate for Payer: Humana Medicare Advantage |
$18.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.92
|
|
|
IMMUNOFIXATION ELECTROPHORESIS
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
38479105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$60.76
|
| Rate for Payer: Aetna Medicare Advantage |
$72.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$80.64
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.34
|
| Rate for Payer: Clover Medicare Advantage |
$21.22
|
| Rate for Payer: EmblemHealth Commercial |
$67.02
|
| Rate for Payer: Humana Medicare Advantage |
$23.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.63
|
|
|
IMMUNOFIXATION ELECTROPHORESIS
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
38479105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.80
|
|
