|
ARBOVIRAL ENCEPHALITIS A/B IGM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
38476198
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$134.00 |
| 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 |
$134.00
|
| 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 |
$80.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.20
|
| 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 |
$7.10
|
|
|
ARBOVIRAL ENCEPHALITIS A/B IGM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
38476198
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$40.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.20
|
|
|
ARBOVIRAL ENCEPHALITIS IGG I
|
Facility
|
OP
|
$67.25
|
|
|
Service Code
|
HCPCS 86651
|
| Hospital Charge Code |
3038529A
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.18
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|
|
ARBOVIRAL ENCEPHALITIS IGG I
|
Facility
|
IP
|
$67.25
|
|
|
Service Code
|
HCPCS 86651
|
| Hospital Charge Code |
3038529A
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$10.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
ARBOVIRAL ENCEPHALITIS IGG I
|
Facility
|
IP
|
$67.25
|
|
|
Service Code
|
HCPCS 86651
|
| Hospital Charge Code |
3038528A
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$10.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
ARBOVIRAL ENCEPHALITIS IGG I
|
Facility
|
OP
|
$67.25
|
|
|
Service Code
|
HCPCS 86651
|
| Hospital Charge Code |
3038528A
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.18
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|
|
ARBOVIRAL ENCEPHALITIS IGG II
|
Facility
|
IP
|
$90.65
|
|
|
Service Code
|
HCPCS 86652
|
| Hospital Charge Code |
3038528B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.60
|
|
|
ARBOVIRAL ENCEPHALITIS IGG II
|
Facility
|
OP
|
$90.65
|
|
|
Service Code
|
HCPCS 86652
|
| Hospital Charge Code |
3038528B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.40
|
|
|
ARBOVIRAL ENCEPHALITIS IGG III
|
Facility
|
IP
|
$90.65
|
|
|
Service Code
|
HCPCS 86653
|
| Hospital Charge Code |
3038528C
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.60
|
|
|
ARBOVIRAL ENCEPHALITIS IGG III
|
Facility
|
OP
|
$90.65
|
|
|
Service Code
|
HCPCS 86653
|
| Hospital Charge Code |
3038528C
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.40
|
|
|
ARBOVIRAL ENCEPHALITIS IGG IV
|
Facility
|
OP
|
$90.65
|
|
|
Service Code
|
HCPCS 86654
|
| Hospital Charge Code |
3038528D
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.40
|
|
|
ARBOVIRAL ENCEPHALITIS IGG IV
|
Facility
|
IP
|
$90.65
|
|
|
Service Code
|
HCPCS 86654
|
| Hospital Charge Code |
3038528D
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.60
|
|
|
ARBOVIRAL ENCEPHALITIS IGM II
|
Facility
|
IP
|
$90.65
|
|
|
Service Code
|
HCPCS 86652
|
| Hospital Charge Code |
3038529B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.60
|
|
|
ARBOVIRAL ENCEPHALITIS IGM II
|
Facility
|
OP
|
$90.65
|
|
|
Service Code
|
HCPCS 86652
|
| Hospital Charge Code |
3038529B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.40
|
|
|
ARBOVIRAL ENCEPHALITIS IGM III
|
Facility
|
OP
|
$90.65
|
|
|
Service Code
|
HCPCS 86653
|
| Hospital Charge Code |
3038529C
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.40
|
|
|
ARBOVIRAL ENCEPHALITIS IGM III
|
Facility
|
IP
|
$90.65
|
|
|
Service Code
|
HCPCS 86653
|
| Hospital Charge Code |
3038529C
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.60
|
|
|
ARBOVIRAL ENCEPHALITIS IGM IV
|
Facility
|
OP
|
$90.65
|
|
|
Service Code
|
HCPCS 86654
|
| Hospital Charge Code |
3038529D
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.40
|
|
|
ARBOVIRAL ENCEPHALITIS IGM IV
|
Facility
|
IP
|
$90.65
|
|
|
Service Code
|
HCPCS 86654
|
| Hospital Charge Code |
3038529D
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.60
|
|
|
ARBOVIRAL ENCEPHALTIS A/B IGG
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
38476196
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$40.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.20
|
|
|
ARBOVIRAL ENCEPHALTIS A/B IGG
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
38476196
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$134.00 |
| 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 |
$134.00
|
| 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 |
$80.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.20
|
| 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 |
$7.10
|
|
|
ARBOVIRUS AB PANEL
|
Facility
|
OP
|
$2,441.00
|
|
|
Service Code
|
HCPCS 86652
|
| Hospital Charge Code |
397041415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$1,220.50 |
| Rate for Payer: Aetna Commercial |
$35.88
|
| Rate for Payer: Aetna Medicare Advantage |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.61
|
| Rate for Payer: Cigna Commercial |
$1,220.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.19
|
| Rate for Payer: Clover Medicare Advantage |
$12.53
|
| Rate for Payer: EmblemHealth Commercial |
$39.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.59
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$732.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$366.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$64.69
|
|
|
ARBOVIRUS AB PANEL
|
Facility
|
IP
|
$2,441.00
|
|
|
Service Code
|
HCPCS 86652
|
| Hospital Charge Code |
397041415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$366.15 |
| Max. Negotiated Rate |
$366.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$366.15
|
|
|
ARBOVIRUS AB PANL,IFA,SER I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8665291
|
| Hospital Charge Code |
39990093D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.45
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
ARBOVIRUS AB PANL,IFA,SER I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8665291
|
| Hospital Charge Code |
39990093C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.45
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
ARBOVIRUS AB PANL,IFA,SER I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8665191
|
| Hospital Charge Code |
39990093B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
