|
ANTIDIURETIC HORMONE I
|
Facility
|
OP
|
$91.25
|
|
|
Service Code
|
HCPCS 83930
|
| Hospital Charge Code |
3007150A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$17.98
|
| Rate for Payer: Aetna Medicare Advantage |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.86
|
| Rate for Payer: Cigna Commercial |
$45.62
|
| Rate for Payer: Cigna Medicare Advantage |
$6.61
|
| Rate for Payer: Clover Medicare Advantage |
$6.28
|
| Rate for Payer: EmblemHealth Commercial |
$19.83
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.38
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.42
|
|
|
ANTIDIURETIC HORMONE II
|
Facility
|
OP
|
$383.25
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
3007150B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$191.62 |
| Rate for Payer: Aetna Commercial |
$92.32
|
| Rate for Payer: Aetna Medicare Advantage |
$109.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$122.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$122.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$33.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$122.51
|
| Rate for Payer: Cigna Commercial |
$191.62
|
| Rate for Payer: Cigna Medicare Advantage |
$33.94
|
| Rate for Payer: Clover Medicare Advantage |
$32.24
|
| Rate for Payer: EmblemHealth Commercial |
$101.82
|
| Rate for Payer: Humana Medicare Advantage |
$34.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$33.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.97
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$33.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.16
|
|
|
ANTIDIURETIC HORMONE II
|
Facility
|
IP
|
$383.25
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
3007150B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$57.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.49
|
|
|
ANTIDIURETIC HORMONE PANEL
|
Facility
|
OP
|
$474.50
|
|
| Hospital Charge Code |
3007150
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$237.25 |
| Rate for Payer: Aetna Commercial |
$180.31
|
| Rate for Payer: Aetna Medicare Advantage |
$142.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$121.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$121.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$121.00
|
| Rate for Payer: Cigna Commercial |
$237.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$142.35
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.57
|
|
|
ANTIDIURETIC HORMONE PANEL
|
Facility
|
IP
|
$474.50
|
|
| Hospital Charge Code |
3007150
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.17 |
| Max. Negotiated Rate |
$71.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.17
|
|
|
ANTI DNA, DOUBLE STRANDED
|
Facility
|
OP
|
$175.25
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
3008323
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$37.37
|
| Rate for Payer: Aetna Medicare Advantage |
$44.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.74
|
| 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 |
$49.60
|
| Rate for Payer: Cigna Commercial |
$87.62
|
| Rate for Payer: Cigna Medicare Advantage |
$13.74
|
| Rate for Payer: Clover Medicare Advantage |
$13.05
|
| Rate for Payer: EmblemHealth Commercial |
$41.22
|
| Rate for Payer: Humana Medicare Advantage |
$14.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.58
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.64
|
|
|
ANTI DNA, DOUBLE STRANDED
|
Facility
|
IP
|
$175.25
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
3008323
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$26.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.29
|
|
|
ANTI-DNA(DOUBLE STRANDED)ANTIB
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
38476042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.99 |
| Max. Negotiated Rate |
$289.50 |
| Rate for Payer: Aetna Commercial |
$37.37
|
| Rate for Payer: Aetna Medicare Advantage |
$44.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.74
|
| 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 |
$49.60
|
| Rate for Payer: Cigna Commercial |
$289.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.74
|
| Rate for Payer: Clover Medicare Advantage |
$13.05
|
| Rate for Payer: EmblemHealth Commercial |
$41.22
|
| Rate for Payer: Humana Medicare Advantage |
$14.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.34
|
|
|
ANTI-DNA(DOUBLE STRANDED)ANTIB
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
38476042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.85 |
| Max. Negotiated Rate |
$86.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.85
|
|
|
ANTI DNA-DS
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
39900362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$37.37
|
| Rate for Payer: Aetna Medicare Advantage |
$44.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.74
|
| 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 |
$49.60
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$13.74
|
| Rate for Payer: Clover Medicare Advantage |
$13.05
|
| Rate for Payer: EmblemHealth Commercial |
$41.22
|
| Rate for Payer: Humana Medicare Advantage |
$14.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.74
|
| 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 |
$10.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
ANTI DNA-DS
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
39900362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ANTI DNASE B(STREPTOCOCCAL)ANT
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 86215
|
| Hospital Charge Code |
38476048
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$136.50 |
| 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 |
$35.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.83
|
| Rate for Payer: Cigna Commercial |
$136.50
|
| 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 |
$81.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.95
|
| 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 |
$7.23
|
|
|
ANTI DNASE B(STREPTOCOCCAL)ANT
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 86215
|
| Hospital Charge Code |
38476048
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.95
|
|
|
ANTI DNASE STREPTOCOCCAL
|
Facility
|
OP
|
$136.85
|
|
|
Service Code
|
HCPCS 86215
|
| Hospital Charge Code |
3003647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.63 |
| 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 |
$35.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.83
|
| Rate for Payer: Cigna Commercial |
$68.42
|
| 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 |
$41.05
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.53
|
| 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 |
$3.63
|
|
|
ANTI DNASE STREPTOCOCCAL
|
Facility
|
IP
|
$136.85
|
|
|
Service Code
|
HCPCS 86215
|
| Hospital Charge Code |
3003647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$20.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.53
|
|
|
ANTI DNA, SINGLE STRANDED
|
Facility
|
OP
|
$205.65
|
|
|
Service Code
|
HCPCS 86226
|
| Hospital Charge Code |
3008331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.94
|
| Rate for Payer: Aetna Medicare Advantage |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.71
|
| Rate for Payer: Cigna Commercial |
$102.83
|
| Rate for Payer: Cigna Medicare Advantage |
$12.11
|
| Rate for Payer: Clover Medicare Advantage |
$11.50
|
| Rate for Payer: EmblemHealth Commercial |
$36.33
|
| Rate for Payer: Humana Medicare Advantage |
$12.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.45
|
|
|
ANTI DNA, SINGLE STRANDED
|
Facility
|
IP
|
$205.65
|
|
|
Service Code
|
HCPCS 86226
|
| Hospital Charge Code |
3008331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$30.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.85
|
|
|
ANTI-DNA(SINGLE STRANDED)ANTIB
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
HCPCS 86226
|
| Hospital Charge Code |
38476045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: Aetna Commercial |
$32.94
|
| Rate for Payer: Aetna Medicare Advantage |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.71
|
| Rate for Payer: Cigna Commercial |
$271.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.11
|
| Rate for Payer: Clover Medicare Advantage |
$11.50
|
| Rate for Payer: EmblemHealth Commercial |
$36.33
|
| Rate for Payer: Humana Medicare Advantage |
$12.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.36
|
|
|
ANTI-DNA(SINGLE STRANDED)ANTIB
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
HCPCS 86226
|
| Hospital Charge Code |
38476045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.30 |
| Max. Negotiated Rate |
$81.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.30
|
|
|
ANTI-ENA(SM&SM.RNP) AB
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
38479092
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$26.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.85
|
|
|
ANTI-ENA(SM&SM.RNP) AB
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
38479092
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: Aetna Medicare Advantage |
$58.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.72
|
| Rate for Payer: Cigna Commercial |
$89.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.93
|
| Rate for Payer: Clover Medicare Advantage |
$17.03
|
| Rate for Payer: EmblemHealth Commercial |
$53.79
|
| Rate for Payer: Humana Medicare Advantage |
$18.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.74
|
|
|
ANTI-EPIDERMAL AB SCREEN
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
3009800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$124.00 |
| 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 |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.50
|
| Rate for Payer: Cigna Commercial |
$60.50
|
| 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 |
$36.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
| 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 |
$3.21
|
|
|
ANTI-EPIDERMAL AB SCREEN
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
3009800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
ANTIEPILEPTICS NOS 1-3
|
Facility
|
OP
|
$190.45
|
|
|
Service Code
|
HCPCS 80339
|
| Hospital Charge Code |
39990219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$72.37
|
| Rate for Payer: Aetna Medicare Advantage |
$57.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.56
|
| Rate for Payer: Cigna Commercial |
$95.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.13
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.05
|
|
|
ANTIEPILEPTICS NOS 1-3
|
Facility
|
IP
|
$190.45
|
|
|
Service Code
|
HCPCS 80339
|
| Hospital Charge Code |
39990219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.57 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.57
|
|
