|
HSV 2 AB IGM
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38479447
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$391.36 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$391.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.72
|
| Rate for Payer: Cigna Commercial |
$255.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$132.86
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.51
|
|
|
HSV 2 AB, IGM
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38476123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.65 |
| Max. Negotiated Rate |
$76.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.65
|
|
|
HSV 2 AB, IGM
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38476123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$391.36 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$391.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.72
|
| Rate for Payer: Cigna Commercial |
$255.50
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$132.86
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.51
|
|
|
HSV 2 IGG
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
39900381
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HSV 2 IGG
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
39900381
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$52.63
|
| Rate for Payer: Aetna Medicare Advantage |
$62.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.19
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$19.35
|
| Rate for Payer: Clover Medicare Advantage |
$18.38
|
| Rate for Payer: EmblemHealth Commercial |
$58.05
|
| Rate for Payer: Humana Medicare Advantage |
$19.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.35
|
| 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 |
$15.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HSV 2 IGM TITER
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
3000378C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$52.63
|
| Rate for Payer: Aetna Medicare Advantage |
$62.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.19
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$19.35
|
| Rate for Payer: Clover Medicare Advantage |
$18.38
|
| Rate for Payer: EmblemHealth Commercial |
$58.05
|
| Rate for Payer: Humana Medicare Advantage |
$19.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.35
|
| 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 |
$15.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HSV 2 IGM TITER
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
3000378C
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HSV 2 IGM TITER 2ND
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 8669691
|
| Hospital Charge Code |
3000378D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HSV 2 IGM TITER 2ND
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 8669691
|
| Hospital Charge Code |
3000378D
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.45
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| 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 |
$12.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HSV CULTURE,W/REFL TO TYP
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87255
|
| Hospital Charge Code |
39900497
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$92.10
|
| Rate for Payer: Aetna Medicare Advantage |
$109.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$122.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$122.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$33.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$122.83
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$33.86
|
| Rate for Payer: Clover Medicare Advantage |
$32.17
|
| Rate for Payer: EmblemHealth Commercial |
$101.58
|
| Rate for Payer: Humana Medicare Advantage |
$34.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$33.86
|
| 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 |
$27.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$33.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HSV CULTURE,W/REFL TO TYP
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87255
|
| Hospital Charge Code |
39900497
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HSV TYPE 2
|
Facility
|
IP
|
$38.35
|
|
|
Service Code
|
HCPCS 87140
|
| Hospital Charge Code |
39900271
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.75
|
|
|
HSV TYPE 2
|
Facility
|
OP
|
$38.35
|
|
|
Service Code
|
HCPCS 87140
|
| Hospital Charge Code |
39900271
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: Aetna Medicare Advantage |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.21
|
| Rate for Payer: Cigna Commercial |
$19.18
|
| Rate for Payer: Cigna Medicare Advantage |
$5.57
|
| Rate for Payer: Clover Medicare Advantage |
$5.29
|
| Rate for Payer: EmblemHealth Commercial |
$16.71
|
| Rate for Payer: Humana Medicare Advantage |
$5.74
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.97
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.46
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.09
|
|
|
HSV/VZV
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
401387254
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HSV/VZV
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
401387254A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HSV/VZV
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
401387254
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$53.20
|
| Rate for Payer: Aetna Medicare Advantage |
$63.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.95
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$19.56
|
| Rate for Payer: Clover Medicare Advantage |
$18.58
|
| Rate for Payer: EmblemHealth Commercial |
$58.68
|
| Rate for Payer: Humana Medicare Advantage |
$20.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.56
|
| 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 |
$15.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HSV/VZV
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
401387254A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$53.20
|
| Rate for Payer: Aetna Medicare Advantage |
$63.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$19.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.95
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$19.56
|
| Rate for Payer: Clover Medicare Advantage |
$18.58
|
| Rate for Payer: EmblemHealth Commercial |
$58.68
|
| Rate for Payer: Humana Medicare Advantage |
$20.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$19.56
|
| 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 |
$15.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HTLV 1&2 AB
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
39900388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HTLV 1&2 AB
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
39900388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$391.36 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$391.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.72
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| 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 |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
HTLV-1 AB, IGG
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
HCPCS 86687
|
| Hospital Charge Code |
38476237
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$24.72
|
| Rate for Payer: Aetna Medicare Advantage |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.09
|
| 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 |
$32.97
|
| Rate for Payer: Cigna Commercial |
$208.00
|
| Rate for Payer: Cigna Medicare Advantage |
$9.09
|
| Rate for Payer: Clover Medicare Advantage |
$8.64
|
| Rate for Payer: EmblemHealth Commercial |
$27.27
|
| Rate for Payer: Humana Medicare Advantage |
$9.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.16
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.81
|
|
|
HTLV-1 AB, IGG
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
HCPCS 86687
|
| Hospital Charge Code |
38476237
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.40
|
|
|
HTLV/II,IGE
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38476273
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$391.36 |
| Rate for Payer: Aetna Commercial |
$35.03
|
| Rate for Payer: Aetna Medicare Advantage |
$41.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$391.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.72
|
| Rate for Payer: Cigna Commercial |
$109.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.88
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.68
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.19
|
|
|
HTLV/II,IGE
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38476273
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$32.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.70
|
|
|
HTO IBALANCE XL 9 DEG
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.80 |
| Max. Negotiated Rate |
$4,750.00 |
| Rate for Payer: Aetna Commercial |
$3,610.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,422.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,422.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,422.50
|
| Rate for Payer: Cigna Commercial |
$4,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,299.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$300.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.80
|
|
|
HTO IBALANCE XL 9 DEG
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$2,299.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,299.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
