|
HEPATITIS PANEL
|
Facility
|
OP
|
$37.50
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
39900420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$172.78 |
| Rate for Payer: Aetna Commercial |
$129.55
|
| Rate for Payer: Aetna Medicare Advantage |
$154.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.78
|
| Rate for Payer: Cigna Commercial |
$18.75
|
| Rate for Payer: Cigna Medicare Advantage |
$47.63
|
| Rate for Payer: Clover Medicare Advantage |
$45.25
|
| Rate for Payer: EmblemHealth Commercial |
$142.89
|
| Rate for Payer: Humana Medicare Advantage |
$49.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$47.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.75
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$47.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
HEPATITIS PANEL
|
Facility
|
IP
|
$37.50
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
39900420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.62
|
|
|
HEPATITIS PANEL-SO
|
Facility
|
OP
|
$551.86
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
401380074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.67 |
| Max. Negotiated Rate |
$275.93 |
| Rate for Payer: Aetna Commercial |
$129.55
|
| Rate for Payer: Aetna Medicare Advantage |
$154.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.78
|
| Rate for Payer: Cigna Commercial |
$275.93
|
| Rate for Payer: Cigna Medicare Advantage |
$47.63
|
| Rate for Payer: Clover Medicare Advantage |
$45.25
|
| Rate for Payer: EmblemHealth Commercial |
$142.89
|
| Rate for Payer: Humana Medicare Advantage |
$49.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$47.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.48
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$47.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.67
|
|
|
HEPATITIS PANEL-SO
|
Facility
|
IP
|
$551.86
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
401380074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.78 |
| Max. Negotiated Rate |
$82.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.78
|
|
|
HEPATITIS PROF.
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
38479101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$194.55 |
| Max. Negotiated Rate |
$194.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.55
|
|
|
HEPATITIS PROF.
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
38479101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.83 |
| Max. Negotiated Rate |
$648.50 |
| Rate for Payer: Aetna Commercial |
$129.55
|
| Rate for Payer: Aetna Medicare Advantage |
$154.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.78
|
| Rate for Payer: Cigna Commercial |
$648.50
|
| Rate for Payer: Cigna Medicare Advantage |
$47.63
|
| Rate for Payer: Clover Medicare Advantage |
$45.25
|
| Rate for Payer: EmblemHealth Commercial |
$142.89
|
| Rate for Payer: Humana Medicare Advantage |
$49.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$47.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$337.22
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$47.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.83
|
|
|
HEPATITIS PROFILE
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
38472330
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$194.55 |
| Max. Negotiated Rate |
$194.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.55
|
|
|
HEPATITIS PROFILE
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
38472330
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.83 |
| Max. Negotiated Rate |
$648.50 |
| Rate for Payer: Aetna Commercial |
$129.55
|
| Rate for Payer: Aetna Medicare Advantage |
$154.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.78
|
| Rate for Payer: Cigna Commercial |
$648.50
|
| Rate for Payer: Cigna Medicare Advantage |
$47.63
|
| Rate for Payer: Clover Medicare Advantage |
$45.25
|
| Rate for Payer: EmblemHealth Commercial |
$142.89
|
| Rate for Payer: Humana Medicare Advantage |
$49.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$47.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$337.22
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$47.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.83
|
|
|
HEPATITS A VIRUS
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
38479443
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.90
|
|
|
HEPATITS A VIRUS
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
38479443
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Medicare Advantage |
$40.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.94
|
| 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 |
$28.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.94
|
| Rate for Payer: Cigna Commercial |
$213.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.39
|
| 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: Longevity Health Plan of New Jersey Medicare Advantage |
$12.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.76
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.10
|
|
|
HEPATITS B SURFACE AB QUA
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
39900211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITS B SURFACE AB QUA
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
39900211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$40.77
|
| Rate for Payer: Aetna Medicare Advantage |
$48.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.38
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.99
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.99
|
| 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 |
$11.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HEPATITS B VIRUS DNA QUANT PCR
|
Facility
|
OP
|
$2,190.80
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
3038539
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$1,095.40 |
| 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 |
$1,095.40
|
| 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 |
$569.61
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.62
|
| 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 |
$62.22
|
|
|
HEPATITS B VIRUS DNA QUANT PCR
|
Facility
|
IP
|
$2,190.80
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
3038539
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$328.62 |
| Max. Negotiated Rate |
$328.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.62
|
|
|
HEPATITS PANEL NON-ACUTE I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
39990133A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITS PANEL NON-ACUTE I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
39990133A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$195.00
|
| 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 |
$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 |
$9.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HEPATITS PANEL NON-ACUTE II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
39990133B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITS PANEL NON-ACUTE II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
39990133B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$29.21
|
| Rate for Payer: Aetna Medicare Advantage |
$34.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.74
|
| 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 |
$38.96
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.74
|
| Rate for Payer: Clover Medicare Advantage |
$10.20
|
| Rate for Payer: EmblemHealth Commercial |
$32.22
|
| Rate for Payer: Humana Medicare Advantage |
$11.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.74
|
| 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 |
$8.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HEPATITS PANEL NON-ACUTE III
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
39990133C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$38.81
|
| Rate for Payer: Aetna Medicare Advantage |
$46.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.76
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.27
|
| Rate for Payer: Clover Medicare Advantage |
$13.56
|
| Rate for Payer: EmblemHealth Commercial |
$42.81
|
| Rate for Payer: Humana Medicare Advantage |
$14.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.27
|
| 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 |
$11.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HEPATITS PANEL NON-ACUTE III
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
39990133C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITS PANEL NON-ACUTE IV
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
39990133D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITS PANEL NON-ACUTE IV
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
39990133D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$38.81
|
| Rate for Payer: Aetna Medicare Advantage |
$46.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.76
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.27
|
| Rate for Payer: Clover Medicare Advantage |
$13.56
|
| Rate for Payer: EmblemHealth Commercial |
$42.81
|
| Rate for Payer: Humana Medicare Advantage |
$14.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.27
|
| 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 |
$11.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HEPATITS PANEL NON-ACUTE V
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
39990133E
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEPATITS PANEL NON-ACUTE V
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
39990133E
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$28.10
|
| Rate for Payer: Aetna Medicare Advantage |
$33.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.47
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.33
|
| Rate for Payer: Clover Medicare Advantage |
$9.81
|
| Rate for Payer: EmblemHealth Commercial |
$30.99
|
| Rate for Payer: Humana Medicare Advantage |
$10.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.33
|
| 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 |
$8.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC
|
Facility
|
IP
|
$74,358.46
|
|
|
Service Code
|
MSDRG 421
|
| Min. Negotiated Rate |
$22,641.20 |
| Max. Negotiated Rate |
$74,358.46 |
| Rate for Payer: Aetna Commercial |
$54,817.46
|
| Rate for Payer: Aetna Medicare Advantage |
$74,358.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47,375.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47,375.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$23,832.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47,375.55
|
| Rate for Payer: Cigna Commercial |
$38,734.09
|
| Rate for Payer: Cigna Medicare Advantage |
$23,832.84
|
| Rate for Payer: Clover Medicare Advantage |
$22,641.20
|
| Rate for Payer: EmblemHealth Commercial |
$71,498.52
|
| Rate for Payer: Humana Medicare Advantage |
$24,547.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$23,832.84
|
| Rate for Payer: Oxford Commercial |
$30,614.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$40,978.94
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$23,832.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$23,832.84
|
|
