|
ASPERGILLUS #1
|
Facility
|
OP
|
$139.25
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
3009636C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.76
|
| Rate for Payer: Aetna Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$55.14
|
| Rate for Payer: Cigna Commercial |
$15.05
|
| Rate for Payer: Cigna Medicare Advantage |
$7.53
|
| Rate for Payer: Clover Medicare Advantage |
$14.30
|
| Rate for Payer: EmblemHealth Commercial |
$45.15
|
| Rate for Payer: Humana Medicare Advantage |
$15.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.05
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.05
|
|
|
ASPERGILLUS #1
|
Facility
|
IP
|
$139.25
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
3009636C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$20.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
|
|
ASPERGILLUS AB,COMP FIXATION
|
Facility
|
OP
|
$100.85
|
|
|
Service Code
|
HCPCS 86171
|
| Hospital Charge Code |
3004083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Medicare Advantage |
$10.01
|
| Rate for Payer: Aetna Commercial |
$32.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.68
|
| Rate for Payer: Cigna Commercial |
$10.01
|
| Rate for Payer: Cigna Medicare Advantage |
$5.00
|
| Rate for Payer: Clover Medicare Advantage |
$9.51
|
| Rate for Payer: EmblemHealth Commercial |
$30.03
|
| Rate for Payer: Humana Medicare Advantage |
$10.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.11
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.01
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$10.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.01
|
|
|
ASPERGILLUS AB,COMP FIXATION
|
Facility
|
IP
|
$100.85
|
|
|
Service Code
|
HCPCS 86171
|
| Hospital Charge Code |
3004083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.13
|
|
|
ASPERGILLUS AB, ID, I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8660691
|
| Hospital Charge Code |
39990032A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| 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 |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
ASPERGILLUS AB, ID, I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8660691
|
| Hospital Charge Code |
39990032A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ASPERGILLUS AB, ID, II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8660691
|
| Hospital Charge Code |
39990032B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ASPERGILLUS AB, ID, II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8660691
|
| Hospital Charge Code |
39990032B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| 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 |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
ASPERGILLUS AB, ID, III
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8660691
|
| Hospital Charge Code |
39990032C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ASPERGILLUS AB, ID, III
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8660691
|
| Hospital Charge Code |
39990032C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| 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 |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
ASPERGILLUS AB IMMUNODIFFUSION
|
Facility
|
OP
|
$139.25
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
3032190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.76
|
| Rate for Payer: Aetna Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$55.14
|
| Rate for Payer: Cigna Commercial |
$15.05
|
| Rate for Payer: Cigna Medicare Advantage |
$7.53
|
| Rate for Payer: Clover Medicare Advantage |
$14.30
|
| Rate for Payer: EmblemHealth Commercial |
$45.15
|
| Rate for Payer: Humana Medicare Advantage |
$15.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.05
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.05
|
|
|
ASPERGILLUS AB IMMUNODIFFUSION
|
Facility
|
IP
|
$139.25
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
3032190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$20.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
|
|
ASPERGILLUS ANTIGEN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
39900283
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$38.82
|
| Rate for Payer: Aetna Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.89
|
| 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 |
$28.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.89
|
| Rate for Payer: Cigna Commercial |
$11.98
|
| Rate for Payer: Cigna Medicare Advantage |
$5.99
|
| 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: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
|
|
ASPERGILLUS ANTIGEN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
39900283
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ASPERGILLUS DNA,QL PCR I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8779891
|
| Hospital Charge Code |
39990119A
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ASPERGILLUS DNA,QL PCR I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8779891
|
| Hospital Charge Code |
39990119A
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| 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 |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
ASPERGILLUS DNA,QL PCR II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8779891
|
| Hospital Charge Code |
39990119B
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| 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 |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
ASPERGILLUS DNA,QL PCR II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8779891
|
| Hospital Charge Code |
39990119B
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ASPERGILLUS DNA,QL PCR III
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8779891
|
| Hospital Charge Code |
39990119C
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ASPERGILLUS DNA,QL PCR III
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8779891
|
| Hospital Charge Code |
39990119C
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| 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 |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
ASPERGILUS #2
|
Facility
|
IP
|
$139.25
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
3009636D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$20.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
|
|
ASPERGILUS #2
|
Facility
|
OP
|
$139.25
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
3009636D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.76
|
| Rate for Payer: Aetna Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$55.14
|
| Rate for Payer: Cigna Commercial |
$15.05
|
| Rate for Payer: Cigna Medicare Advantage |
$7.53
|
| Rate for Payer: Clover Medicare Advantage |
$14.30
|
| Rate for Payer: EmblemHealth Commercial |
$45.15
|
| Rate for Payer: Humana Medicare Advantage |
$15.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.05
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.05
|
|
|
ASPERIGILLUS AB
|
Facility
|
IP
|
$139.25
|
|
|
Service Code
|
HCPCS 8660691
|
| Hospital Charge Code |
3004082B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$20.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
|
|
ASPERIGILLUS AB
|
Facility
|
IP
|
$139.25
|
|
|
Service Code
|
HCPCS 8660691
|
| Hospital Charge Code |
3004082A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$20.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
|
|
ASPERIGILLUS AB
|
Facility
|
IP
|
$139.25
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
3004082C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$20.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
|