|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
IP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904F
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
IP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904D
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
IP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904I
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
OP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904E
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.52
|
| Rate for Payer: Cigna Commercial |
$26.07
|
| Rate for Payer: Cigna Medicare Advantage |
$13.04
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$27.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
IP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904H
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
OP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904I
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.52
|
| Rate for Payer: Cigna Commercial |
$26.07
|
| Rate for Payer: Cigna Medicare Advantage |
$13.04
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$27.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
IP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904B
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
IP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904J
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
OP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904H
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.52
|
| Rate for Payer: Cigna Commercial |
$26.07
|
| Rate for Payer: Cigna Medicare Advantage |
$13.04
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$27.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
OP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904B
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.52
|
| Rate for Payer: Cigna Commercial |
$26.07
|
| Rate for Payer: Cigna Medicare Advantage |
$13.04
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$27.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
OP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904D
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.52
|
| Rate for Payer: Cigna Commercial |
$26.07
|
| Rate for Payer: Cigna Medicare Advantage |
$13.04
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$27.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
OP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904G
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.52
|
| Rate for Payer: Cigna Commercial |
$26.07
|
| Rate for Payer: Cigna Medicare Advantage |
$13.04
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$27.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
OP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904A
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.52
|
| Rate for Payer: Cigna Commercial |
$26.07
|
| Rate for Payer: Cigna Medicare Advantage |
$13.04
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$27.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
OP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904C
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.52
|
| Rate for Payer: Cigna Commercial |
$26.07
|
| Rate for Payer: Cigna Medicare Advantage |
$13.04
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$27.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
OP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904J
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.52
|
| Rate for Payer: Cigna Commercial |
$26.07
|
| Rate for Payer: Cigna Medicare Advantage |
$13.04
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$27.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
IP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904C
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
IP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904G
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
IP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904A
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
OP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904K
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.52
|
| Rate for Payer: Cigna Commercial |
$26.07
|
| Rate for Payer: Cigna Medicare Advantage |
$13.04
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$27.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
IP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904K
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
IP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904E
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
|
|
PHENOTYPE DNA HIV W/CLTEAADDL
|
Facility
|
OP
|
$172.97
|
|
|
Service Code
|
HCPCS 87904
|
| Hospital Charge Code |
401387904F
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cigna Commercial |
$26.07
|
| Rate for Payer: Cigna Medicare Advantage |
$13.04
|
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.52
|
| Rate for Payer: Clover Medicare Advantage |
$24.77
|
| Rate for Payer: EmblemHealth Commercial |
$78.21
|
| Rate for Payer: Humana Medicare Advantage |
$26.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.49
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.07
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$27.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.07
|
|
|
PHENOXYBENZAMINE CAP 10MG
|
Facility
|
IP
|
$7.25
|
|
| Hospital Charge Code |
60627476
|
|
Hospital Revenue Code
|
252
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
|
|
PHENOXYBENZAMINE CAP 10MG
|
Facility
|
OP
|
$7.25
|
|
| Hospital Charge Code |
60627476
|
|
Hospital Revenue Code
|
252
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare Advantage |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.85
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.94
|
| Rate for Payer: Oxford Commercial |
$3.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.62
|
|
|
PHENTERMINE 15 MG CAP
|
Facility
|
OP
|
$9.65
|
|
| Hospital Charge Code |
60629102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare Advantage |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.25
|
| Rate for Payer: Oxford Commercial |
$4.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.83
|
|