|
HPV TYPES 16 & 18 ONLY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87625
|
| Hospital Charge Code |
3039036
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HPV TYPES 16 & 18 ONLY
|
Facility
|
OP
|
$190.45
|
|
|
Service Code
|
HCPCS 87625
|
| Hospital Charge Code |
397061380
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$110.30
|
| Rate for Payer: Aetna Medicare Advantage |
$131.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$147.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$147.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$40.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$147.10
|
| Rate for Payer: Cigna Commercial |
$95.22
|
| Rate for Payer: Cigna Medicare Advantage |
$40.55
|
| Rate for Payer: Clover Medicare Advantage |
$38.52
|
| Rate for Payer: EmblemHealth Commercial |
$121.65
|
| Rate for Payer: Humana Medicare Advantage |
$41.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$40.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.52
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$40.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.41
|
|
|
HPV TYPES 16 & 18 ONLY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87625
|
| Hospital Charge Code |
3039036
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$110.30
|
| Rate for Payer: Aetna Medicare Advantage |
$131.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$147.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$147.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$40.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$147.10
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$40.55
|
| Rate for Payer: Clover Medicare Advantage |
$38.52
|
| Rate for Payer: EmblemHealth Commercial |
$121.65
|
| Rate for Payer: Humana Medicare Advantage |
$41.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$40.55
|
| 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 |
$32.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$40.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HPV TYPES 16 & 18 ONLY
|
Facility
|
IP
|
$241.20
|
|
|
Service Code
|
HCPCS 87625
|
| Hospital Charge Code |
39990236
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.18 |
| Max. Negotiated Rate |
$36.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.18
|
|
|
HPV TYPES 16 & 18 ONLY
|
Facility
|
OP
|
$190.45
|
|
|
Service Code
|
HCPCS 87625
|
| Hospital Charge Code |
38430036
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$110.30
|
| Rate for Payer: Aetna Medicare Advantage |
$131.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$147.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$147.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$40.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$147.10
|
| Rate for Payer: Cigna Commercial |
$95.22
|
| Rate for Payer: Cigna Medicare Advantage |
$40.55
|
| Rate for Payer: Clover Medicare Advantage |
$38.52
|
| Rate for Payer: EmblemHealth Commercial |
$121.65
|
| Rate for Payer: Humana Medicare Advantage |
$41.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$40.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.52
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$40.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.41
|
|
|
HPV TYPES 16 & 18 ONLY
|
Facility
|
OP
|
$241.20
|
|
|
Service Code
|
HCPCS 87625
|
| Hospital Charge Code |
39990236
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$110.30
|
| Rate for Payer: Aetna Medicare Advantage |
$131.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$147.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$147.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$40.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$147.10
|
| Rate for Payer: Cigna Commercial |
$120.60
|
| Rate for Payer: Cigna Medicare Advantage |
$40.55
|
| Rate for Payer: Clover Medicare Advantage |
$38.52
|
| Rate for Payer: EmblemHealth Commercial |
$121.65
|
| Rate for Payer: Humana Medicare Advantage |
$41.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$40.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.71
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$40.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.85
|
|
|
HPV TYPES 16 & 18 ONLY
|
Facility
|
IP
|
$190.45
|
|
|
Service Code
|
HCPCS 87625
|
| Hospital Charge Code |
397061380
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.57 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.57
|
|
|
HPV TYPES 16 & 18 ONLY
|
Facility
|
IP
|
$190.45
|
|
|
Service Code
|
HCPCS 87625
|
| Hospital Charge Code |
38430036
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.57 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.57
|
|
|
H. PYLORI AB (IGA)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
39900376
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.12
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.85
|
| Rate for Payer: Clover Medicare Advantage |
$16.01
|
| Rate for Payer: EmblemHealth Commercial |
$50.55
|
| Rate for Payer: Humana Medicare Advantage |
$17.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.85
|
| 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 |
$13.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
H. PYLORI AB (IGA)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
39900376
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
H. PYLORI AB(IGA)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
3035113
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
H. PYLORI AB(IGA)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
3035113
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.12
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.85
|
| Rate for Payer: Clover Medicare Advantage |
$16.01
|
| Rate for Payer: EmblemHealth Commercial |
$50.55
|
| Rate for Payer: Humana Medicare Advantage |
$17.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.85
|
| 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 |
$13.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
H.PYLORI AB (IGG),IB
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
39900377
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
H.PYLORI AB (IGG),IB
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
39900377
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.12
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.85
|
| Rate for Payer: Clover Medicare Advantage |
$16.01
|
| Rate for Payer: EmblemHealth Commercial |
$50.55
|
| Rate for Payer: Humana Medicare Advantage |
$17.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.85
|
| 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 |
$13.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
H.PYLORI AB (IGM)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
39900237
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.12
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.85
|
| Rate for Payer: Clover Medicare Advantage |
$16.01
|
| Rate for Payer: EmblemHealth Commercial |
$50.55
|
| Rate for Payer: Humana Medicare Advantage |
$17.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.85
|
| 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 |
$13.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
H.PYLORI AB (IGM)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
39900237
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
H.PYLORI,AB,IGM
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
38479103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.12
|
| Rate for Payer: Cigna Commercial |
$540.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.85
|
| Rate for Payer: Clover Medicare Advantage |
$16.01
|
| Rate for Payer: EmblemHealth Commercial |
$50.55
|
| Rate for Payer: Humana Medicare Advantage |
$17.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$280.80
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.67
|
|
|
H.PYLORI,AB,IGM
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
38479103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.00
|
|
|
H.PYLORI AG,QL,STOOL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87338
|
| Hospital Charge Code |
39900285
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$39.11
|
| Rate for Payer: Aetna Medicare Advantage |
$46.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.16
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.38
|
| Rate for Payer: Clover Medicare Advantage |
$13.66
|
| Rate for Payer: EmblemHealth Commercial |
$43.14
|
| Rate for Payer: Humana Medicare Advantage |
$14.81
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.38
|
| 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 |
$11.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
H.PYLORI AG,QL,STOOL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87338
|
| Hospital Charge Code |
39900285
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
H.PYLORI BREATH TEST
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83013
|
| Hospital Charge Code |
39900482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
H.PYLORI BREATH TEST
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83013
|
| Hospital Charge Code |
39900482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$244.35 |
| Rate for Payer: Aetna Commercial |
$183.22
|
| Rate for Payer: Aetna Medicare Advantage |
$218.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$244.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$244.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$67.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$244.35
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$67.36
|
| Rate for Payer: Clover Medicare Advantage |
$63.99
|
| Rate for Payer: EmblemHealth Commercial |
$202.08
|
| Rate for Payer: Humana Medicare Advantage |
$69.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$67.36
|
| 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 |
$53.89
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$67.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$67.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
H.PYLORI,IGG
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
38479102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.12
|
| Rate for Payer: Cigna Commercial |
$540.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.85
|
| Rate for Payer: Clover Medicare Advantage |
$16.01
|
| Rate for Payer: EmblemHealth Commercial |
$50.55
|
| Rate for Payer: Humana Medicare Advantage |
$17.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$280.80
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.67
|
|
|
H.PYLORI,IGG
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
38479102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.00
|
|
|
H.PYLORI (IGG,IGA,IGM) I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8667791
|
| Hospital Charge Code |
39990099A
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
