|
TRYPANOSOMA CRUZI ANTIBODY IGG
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
397071484
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
TRYPANOSOMA CRUZI ANTIBODY IGG
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
397071484
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$40.14
|
| Rate for Payer: Aetna Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.40
|
| Rate for Payer: Cigna Commercial |
$12.39
|
| Rate for Payer: Cigna Medicare Advantage |
$6.20
|
| Rate for Payer: Clover Medicare Advantage |
$11.77
|
| Rate for Payer: EmblemHealth Commercial |
$37.17
|
| Rate for Payer: Humana Medicare Advantage |
$12.76
|
| 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 |
$12.39
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$13.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.39
|
|
|
TRYPSIN
|
Facility
|
IP
|
$585.17
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3035991
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$87.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.78
|
|
|
TRYPSIN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
39900453
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$59.62
|
| Rate for Payer: Aetna Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.42
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Cigna Medicare Advantage |
$9.20
|
| Rate for Payer: Clover Medicare Advantage |
$17.48
|
| Rate for Payer: EmblemHealth Commercial |
$55.20
|
| Rate for Payer: Humana Medicare Advantage |
$18.95
|
| 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 |
$18.40
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$19.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
|
|
TRYPSIN
|
Facility
|
OP
|
$585.17
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3035991
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$59.62
|
| Rate for Payer: Aetna Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.42
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Cigna Medicare Advantage |
$9.20
|
| Rate for Payer: Clover Medicare Advantage |
$17.48
|
| Rate for Payer: EmblemHealth Commercial |
$55.20
|
| Rate for Payer: Humana Medicare Advantage |
$18.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.07
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$19.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
|
|
TRYPSIN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
39900453
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
TRYPSIN 1
|
Facility
|
OP
|
$585.17
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3035991A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$59.62
|
| Rate for Payer: Aetna Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.42
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Cigna Medicare Advantage |
$9.20
|
| Rate for Payer: Clover Medicare Advantage |
$17.48
|
| Rate for Payer: EmblemHealth Commercial |
$55.20
|
| Rate for Payer: Humana Medicare Advantage |
$18.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.07
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$19.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
|
|
TRYPSIN 1
|
Facility
|
IP
|
$585.17
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3035991A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$87.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.78
|
|
|
TRYPSIN 2
|
Facility
|
IP
|
$585.17
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3035991B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$87.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.78
|
|
|
TRYPSIN 2
|
Facility
|
OP
|
$585.17
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3035991B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$59.62
|
| Rate for Payer: Aetna Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.42
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Cigna Medicare Advantage |
$9.20
|
| Rate for Payer: Clover Medicare Advantage |
$17.48
|
| Rate for Payer: EmblemHealth Commercial |
$55.20
|
| Rate for Payer: Humana Medicare Advantage |
$18.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.07
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$19.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
|
|
TRYPSIN 3
|
Facility
|
IP
|
$585.17
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3035991C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$87.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.78
|
|
|
TRYPSIN 3
|
Facility
|
OP
|
$585.17
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3035991C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$59.62
|
| Rate for Payer: Aetna Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.42
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Cigna Medicare Advantage |
$9.20
|
| Rate for Payer: Clover Medicare Advantage |
$17.48
|
| Rate for Payer: EmblemHealth Commercial |
$55.20
|
| Rate for Payer: Humana Medicare Advantage |
$18.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.07
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.40
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$19.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.40
|
|
|
TRYPSIN-BALSAM AEROSOL SPRAY
|
Facility
|
OP
|
$131.25
|
|
| Hospital Charge Code |
60628461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$65.62 |
| Rate for Payer: Aetna Commercial |
$39.38
|
| Rate for Payer: Aetna Medicare Advantage |
$39.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.47
|
| Rate for Payer: Cigna Commercial |
$65.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.06
|
| Rate for Payer: Oxford Commercial |
$65.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.62
|
|
|
TRYPSIN-BALSAM AEROSOL SPRAY
|
Facility
|
IP
|
$131.25
|
|
| Hospital Charge Code |
60628461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.69
|
|
|
TRYPSIN,FECES,24HR,QUANT
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 84490
|
| Hospital Charge Code |
38472667
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$21.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.30
|
|
|
TRYPSIN,FECES,24HR,QUANT
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 84490
|
| Hospital Charge Code |
38472667
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$32.17
|
| Rate for Payer: Aetna Medicare Advantage |
$9.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.38
|
| Rate for Payer: Cigna Commercial |
$9.93
|
| Rate for Payer: Cigna Medicare Advantage |
$4.96
|
| Rate for Payer: Clover Medicare Advantage |
$9.43
|
| Rate for Payer: EmblemHealth Commercial |
$29.79
|
| Rate for Payer: Humana Medicare Advantage |
$10.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.46
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.93
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$10.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.93
|
|
|
TRYPSIN;FECES,QUALITATIVE
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
HCPCS 84488
|
| Hospital Charge Code |
38477050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.75
|
|
|
TRYPSIN;FECES,QUALITATIVE
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
HCPCS 84488
|
| Hospital Charge Code |
38477050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$23.65
|
| Rate for Payer: Aetna Medicare Advantage |
$7.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.75
|
| Rate for Payer: Cigna Commercial |
$7.30
|
| Rate for Payer: Cigna Medicare Advantage |
$3.65
|
| Rate for Payer: Clover Medicare Advantage |
$6.93
|
| Rate for Payer: EmblemHealth Commercial |
$21.90
|
| Rate for Payer: Humana Medicare Advantage |
$7.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.72
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.30
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$7.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.30
|
|
|
TRYPTASE
|
Facility
|
OP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3038116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$55.95
|
| Rate for Payer: Aetna Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.28
|
| Rate for Payer: Cigna Commercial |
$17.27
|
| Rate for Payer: Cigna Medicare Advantage |
$8.63
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.95
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$18.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
|
|
TRYPTASE
|
Facility
|
IP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3038116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.02 |
| Max. Negotiated Rate |
$38.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
|
|
TRYPTASE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
39900454
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
TRYPTASE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
39900454
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$55.95
|
| Rate for Payer: Aetna Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.28
|
| Rate for Payer: Cigna Commercial |
$17.27
|
| Rate for Payer: Cigna Medicare Advantage |
$8.63
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| 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 |
$17.27
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$18.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
|
|
TRYPTASE TRYPTOPHAN***
|
Facility
|
OP
|
$172.00
|
|
| Hospital Charge Code |
3032612
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$51.60
|
| Rate for Payer: Aetna Medicare Advantage |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.86
|
| Rate for Payer: Cigna Commercial |
$86.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.36
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
TRYPTASE TRYPTOPHAN***
|
Facility
|
IP
|
$172.00
|
|
| Hospital Charge Code |
3032612
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$25.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.80
|
|
|
TRYPTICASE KIT
|
Facility
|
OP
|
$147.85
|
|
| Hospital Charge Code |
60628555
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$44.35
|
| Rate for Payer: Aetna Medicare Advantage |
$44.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.70
|
| Rate for Payer: Cigna Commercial |
$73.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.22
|
| Rate for Payer: Oxford Commercial |
$73.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$73.92
|
|