|
HEPATITIS B CORE ANTIBODY,IGM
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
38479433
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$381.50 |
| Rate for Payer: Aetna Commercial |
$32.01
|
| Rate for Payer: Aetna Medicare Advantage |
$38.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$26.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.70
|
| Rate for Payer: Cigna Commercial |
$381.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.77
|
| Rate for Payer: Clover Medicare Advantage |
$11.18
|
| Rate for Payer: EmblemHealth Commercial |
$35.31
|
| Rate for Payer: Humana Medicare Advantage |
$12.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.38
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.67
|
|
|
HEPATITIS B CORE IGM
|
Facility
|
IP
|
$80.90
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
39900522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$12.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.13
|
|
|
HEPATITIS B CORE IGM
|
Facility
|
OP
|
$80.90
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
39900522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$32.01
|
| Rate for Payer: Aetna Medicare Advantage |
$38.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$26.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.70
|
| Rate for Payer: Cigna Commercial |
$40.45
|
| Rate for Payer: Cigna Medicare Advantage |
$11.77
|
| Rate for Payer: Clover Medicare Advantage |
$11.18
|
| Rate for Payer: EmblemHealth Commercial |
$35.31
|
| Rate for Payer: Humana Medicare Advantage |
$12.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.03
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.30
|
|
|
HEPATITIS B,DNA,BDNA
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
38475109
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$240.50 |
| Rate for Payer: Aetna Commercial |
$116.52
|
| Rate for Payer: Aetna Medicare Advantage |
$138.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$155.40
|
| Rate for Payer: Cigna Commercial |
$240.50
|
| Rate for Payer: Cigna Medicare Advantage |
$42.84
|
| Rate for Payer: Clover Medicare Advantage |
$40.70
|
| Rate for Payer: EmblemHealth Commercial |
$128.52
|
| Rate for Payer: Humana Medicare Advantage |
$44.13
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$42.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.06
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$42.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.66
|
|
|
HEPATITIS B,DNA,BDNA
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
38475109
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$72.15 |
| Max. Negotiated Rate |
$72.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.15
|
|
|
HEPATITIS B DNA PCR
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
38478094
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$45.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.15
|
|
|
HEPATITIS B DNA PCR
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
38478094
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$116.52
|
| Rate for Payer: Aetna Medicare Advantage |
$138.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$155.40
|
| Rate for Payer: Cigna Commercial |
$150.50
|
| Rate for Payer: Cigna Medicare Advantage |
$42.84
|
| Rate for Payer: Clover Medicare Advantage |
$40.70
|
| Rate for Payer: EmblemHealth Commercial |
$128.52
|
| Rate for Payer: Humana Medicare Advantage |
$44.13
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$42.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$78.26
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$42.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.55
|
|
|
HEPATITIS BE ANTIBODY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
39900383
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITIS BE ANTIBODY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
39900383
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$31.47
|
| Rate for Payer: Aetna Medicare Advantage |
$37.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.97
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.57
|
| Rate for Payer: Clover Medicare Advantage |
$10.99
|
| Rate for Payer: EmblemHealth Commercial |
$34.71
|
| Rate for Payer: Humana Medicare Advantage |
$11.92
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HEPATITIS BE ANTIBODY HBE AB
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
38479431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
|
|
HEPATITIS BE ANTIBODY HBE AB
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
38479431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$31.47
|
| Rate for Payer: Aetna Medicare Advantage |
$37.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.97
|
| Rate for Payer: Cigna Commercial |
$279.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.57
|
| Rate for Payer: Clover Medicare Advantage |
$10.99
|
| Rate for Payer: EmblemHealth Commercial |
$34.71
|
| Rate for Payer: Humana Medicare Advantage |
$11.92
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.34
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.88
|
|
|
HEPATITIS BE ANTIBODY HBE AB
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
38472359
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
|
|
HEPATITIS BE ANTIBODY HBE AB
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
38472359
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$31.47
|
| Rate for Payer: Aetna Medicare Advantage |
$37.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.97
|
| Rate for Payer: Cigna Commercial |
$279.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.57
|
| Rate for Payer: Clover Medicare Advantage |
$10.99
|
| Rate for Payer: EmblemHealth Commercial |
$34.71
|
| Rate for Payer: Humana Medicare Advantage |
$11.92
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.34
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.88
|
|
|
HEPATITIS BE ANTIGEN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
39900392
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITIS BE ANTIGEN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
39900392
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$31.36
|
| Rate for Payer: Aetna Medicare Advantage |
$37.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.83
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.53
|
| Rate for Payer: Clover Medicare Advantage |
$10.95
|
| Rate for Payer: EmblemHealth Commercial |
$34.59
|
| Rate for Payer: Humana Medicare Advantage |
$11.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HEPATITIS BE ANTIGEN, HBE AG
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
38472356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.10
|
|
|
HEPATITIS BE ANTIGEN, HBE AG
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
38479430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$287.00 |
| 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 |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.71
|
| 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 |
$21.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.71
|
| Rate for Payer: Cigna Commercial |
$287.00
|
| 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 |
$149.24
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| 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 |
$16.30
|
|
|
HEPATITIS BE ANTIGEN, HBE AG
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
38472356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$287.00 |
| 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 |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.71
|
| 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 |
$21.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.71
|
| Rate for Payer: Cigna Commercial |
$287.00
|
| 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 |
$149.24
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| 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 |
$16.30
|
|
|
HEPATITIS BE ANTIGEN, HBE AG
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
38479430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.10
|
|
|
HEPATITIS B GENOTYPE
|
Facility
|
OP
|
$1,769.40
|
|
|
Service Code
|
HCPCS 87912
|
| Hospital Charge Code |
39900309
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.25 |
| Max. Negotiated Rate |
$933.90 |
| Rate for Payer: Aetna Commercial |
$700.26
|
| Rate for Payer: Aetna Medicare Advantage |
$834.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$933.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$933.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$560.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$933.90
|
| Rate for Payer: Cigna Commercial |
$884.70
|
| Rate for Payer: Cigna Medicare Advantage |
$257.45
|
| Rate for Payer: Clover Medicare Advantage |
$244.58
|
| Rate for Payer: EmblemHealth Commercial |
$772.35
|
| Rate for Payer: Humana Medicare Advantage |
$265.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$257.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$460.04
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$265.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$205.96
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$257.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$257.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.25
|
|
|
HEPATITIS B GENOTYPE
|
Facility
|
IP
|
$1,769.40
|
|
|
Service Code
|
HCPCS 87912
|
| Hospital Charge Code |
39900309
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$265.41 |
| Max. Negotiated Rate |
$265.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$265.41
|
|
|
HEPATITIS B-HEMOPHILUS INF B V
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 90748
|
| Hospital Charge Code |
83652341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$22.99 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.25
|
|
|
HEPATITIS B-HEMOPHILUS INF B V
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 90748
|
| Hospital Charge Code |
83652341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$61.82 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Medicare Advantage |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.23
|
| Rate for Payer: Cigna Commercial |
$47.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.70
|
|
|
HEPATITISB IMMUNE GLOB 5ML INJ
|
Facility
|
OP
|
$4,582.80
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
60629108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.15 |
| Max. Negotiated Rate |
$1,109.04 |
| Rate for Payer: Aetna Commercial |
$381.37
|
| Rate for Payer: Aetna Medicare Advantage |
$454.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$508.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$508.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$140.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$148.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$508.61
|
| Rate for Payer: Cigna Medicare Advantage |
$140.21
|
| Rate for Payer: Clover Medicare Advantage |
$133.20
|
| Rate for Payer: EmblemHealth Commercial |
$420.63
|
| Rate for Payer: Humana Medicare Advantage |
$144.42
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$140.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,109.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$687.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$144.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$140.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$130.15
|
|
|
HEPATITISB IMMUNE GLOB 5ML INJ
|
Facility
|
IP
|
$4,582.80
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
60629108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$687.42 |
| Max. Negotiated Rate |
$1,109.04 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,109.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$687.42
|
|
