|
LYME AB IGG, IGM IFA CSF II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8661891
|
| Hospital Charge Code |
39990086B
|
|
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
|
|
|
LYME AB WESTERN BLOT IGG
|
Facility
|
IP
|
$205.65
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
3006831A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$30.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.85
|
|
|
LYME AB WESTERN BLOT IGG
|
Facility
|
OP
|
$205.65
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
3006831A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$42.13
|
| Rate for Payer: Aetna Medicare Advantage |
$50.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.49
|
| 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 |
$55.91
|
| Rate for Payer: Cigna Commercial |
$102.83
|
| Rate for Payer: Cigna Medicare Advantage |
$15.49
|
| Rate for Payer: Clover Medicare Advantage |
$14.72
|
| Rate for Payer: EmblemHealth Commercial |
$46.47
|
| Rate for Payer: Humana Medicare Advantage |
$15.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.49
|
| 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 |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.45
|
|
|
LYME AB WESTERN BLOT IGM
|
Facility
|
IP
|
$205.65
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
3006831B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$30.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.85
|
|
|
LYME AB WESTERN BLOT IGM
|
Facility
|
OP
|
$205.65
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
3006831B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$42.13
|
| Rate for Payer: Aetna Medicare Advantage |
$50.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.49
|
| 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 |
$55.91
|
| Rate for Payer: Cigna Commercial |
$102.83
|
| Rate for Payer: Cigna Medicare Advantage |
$15.49
|
| Rate for Payer: Clover Medicare Advantage |
$14.72
|
| Rate for Payer: EmblemHealth Commercial |
$46.47
|
| Rate for Payer: Humana Medicare Advantage |
$15.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.49
|
| 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 |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.45
|
|
|
LYME ANTIBODIES, IgM, QUANT
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
38476189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.35
|
|
|
LYME ANTIBODIES, IgM, QUANT
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
38476189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.47
|
| Rate for Payer: Cigna Commercial |
$214.50
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.37
|
|
|
LYME ANTIBODIES, QUANT
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
38476186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.47
|
| Rate for Payer: Cigna Commercial |
$271.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| 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 |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.36
|
|
|
LYME ANTIBODIES, QUANT
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
38476186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.30 |
| Max. Negotiated Rate |
$81.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.30
|
|
|
LYME ANTIBODY, CSF
|
Facility
|
OP
|
$128.75
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
3032315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.47
|
| Rate for Payer: Cigna Commercial |
$64.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.62
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.41
|
|
|
LYME ANTIBODY, CSF
|
Facility
|
IP
|
$128.75
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
3032315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.31
|
|
|
LYME CONFIRMATION TEST
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
38476266
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$42.13
|
| Rate for Payer: Aetna Medicare Advantage |
$50.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.49
|
| 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 |
$55.91
|
| Rate for Payer: Cigna Commercial |
$95.00
|
| Rate for Payer: Cigna Medicare Advantage |
$15.49
|
| Rate for Payer: Clover Medicare Advantage |
$14.72
|
| Rate for Payer: EmblemHealth Commercial |
$46.47
|
| Rate for Payer: Humana Medicare Advantage |
$15.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.04
|
|
|
LYME CONFIRMATION TEST
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
38476266
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.50
|
|
|
LYME DISEASE AB W/RFX
|
Facility
|
IP
|
$128.75
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
3032352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.31
|
|
|
LYME DISEASE AB W/RFX
|
Facility
|
OP
|
$128.75
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
3032352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.47
|
| Rate for Payer: Cigna Commercial |
$64.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.62
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.41
|
|
|
LYME DISEASE ANTIBODY
|
Facility
|
OP
|
$128.75
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
3006699
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.47
|
| Rate for Payer: Cigna Commercial |
$64.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.62
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.41
|
|
|
LYME DISEASE ANTIBODY
|
Facility
|
IP
|
$128.75
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
3006699
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.31
|
|
|
LYME DISEASE ANTIBODY, IGM
|
Facility
|
IP
|
$128.75
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
3032316
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.31
|
|
|
LYME DISEASE ANTIBODY, IGM
|
Facility
|
OP
|
$128.75
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
3032316
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.47
|
| Rate for Payer: Cigna Commercial |
$64.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.62
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.41
|
|
|
LYME DISEASE(B.SPP)DNA,SF
|
Facility
|
IP
|
$825.84
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
39900307
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$123.88 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.88
|
|
|
LYME DISEASE(B.SPP)DNA,SF
|
Facility
|
OP
|
$825.84
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
39900307
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$412.92 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: Aetna Medicare Advantage |
$227.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$253.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$253.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$76.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$253.40
|
| Rate for Payer: Cigna Commercial |
$412.92
|
| Rate for Payer: Cigna Medicare Advantage |
$70.20
|
| Rate for Payer: Clover Medicare Advantage |
$66.69
|
| Rate for Payer: EmblemHealth Commercial |
$210.60
|
| Rate for Payer: Humana Medicare Advantage |
$72.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$70.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$247.75
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$56.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.88
|
|
|
LYME DISEASE DNA CSF
|
Facility
|
OP
|
$1,132.80
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
397041356
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$566.40 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: Aetna Medicare Advantage |
$227.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$253.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$253.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$76.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$253.40
|
| Rate for Payer: Cigna Commercial |
$566.40
|
| Rate for Payer: Cigna Medicare Advantage |
$70.20
|
| Rate for Payer: Clover Medicare Advantage |
$66.69
|
| Rate for Payer: EmblemHealth Commercial |
$210.60
|
| Rate for Payer: Humana Medicare Advantage |
$72.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$70.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$339.84
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$169.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$56.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.02
|
|
|
LYME DISEASE DNA CSF
|
Facility
|
IP
|
$1,132.80
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
397041356
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$169.92 |
| Max. Negotiated Rate |
$169.92 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$169.92
|
|
|
Lyme Disease, Total Antibody T
|
Facility
|
IP
|
$117.05
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
39888013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.56
|
|
|
Lyme Disease, Total Antibody T
|
Facility
|
OP
|
$117.05
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
39888013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.47
|
| Rate for Payer: Cigna Commercial |
$58.52
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.12
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.10
|
|
