|
ANTERIOR CHAMBER CANNULA 27G
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
270331004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: Aetna Medicare Advantage |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.03
|
| Rate for Payer: Cigna Commercial |
$27.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.30
|
| Rate for Payer: Oxford Commercial |
$11.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.56
|
|
|
ANTERIOR CHAMBER CANNULA 27G
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
270331004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$8.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.25
|
|
|
ANTERIOR VITRECTOMY PACK
|
Facility
|
IP
|
$1,602.00
|
|
| Hospital Charge Code |
270335274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.30 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$240.30
|
|
|
ANTERIOR VITRECTOMY PACK
|
Facility
|
OP
|
$1,602.00
|
|
| Hospital Charge Code |
270335274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$801.00 |
| Rate for Payer: Aetna Commercial |
$608.76
|
| Rate for Payer: Aetna Medicare Advantage |
$480.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$408.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$408.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$408.51
|
| Rate for Payer: Cigna Commercial |
$801.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$416.52
|
| Rate for Payer: Oxford Commercial |
$320.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$240.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$320.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$50.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.50
|
|
|
ANTG DETET-IMMUNOFLUOR GIARDIA
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87269
|
| Hospital Charge Code |
38477079
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
ANTG DETET-IMMUNOFLUOR GIARDIA
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87269
|
| Hospital Charge Code |
38477079
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$37.02
|
| Rate for Payer: Aetna Medicare Advantage |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.37
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.61
|
| Rate for Payer: Clover Medicare Advantage |
$12.93
|
| Rate for Payer: EmblemHealth Commercial |
$40.83
|
| Rate for Payer: Humana Medicare Advantage |
$14.02
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.89
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
ANTG-DET.IMMNFL-HERPES SIMP VI
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87274
|
| Hospital Charge Code |
38477082
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Medicare Advantage |
$38.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.46
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.98
|
| Rate for Payer: Clover Medicare Advantage |
$11.38
|
| Rate for Payer: EmblemHealth Commercial |
$35.94
|
| Rate for Payer: Humana Medicare Advantage |
$12.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
ANTG-DET.IMMNFL-HERPES SIMP VI
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87274
|
| Hospital Charge Code |
38477082
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
ANTG DET IMMN.FLUORINFLUENZA A
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87276
|
| Hospital Charge Code |
38477084
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$43.71
|
| Rate for Payer: Aetna Medicare Advantage |
$52.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.29
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$16.07
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
ANTG DET IMMN.FLUORINFLUENZA A
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87276
|
| Hospital Charge Code |
38477084
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
ANTG DET IMMUFL-PNEUMOCYSTIS
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87281
|
| Hospital Charge Code |
38477088
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Medicare Advantage |
$38.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.46
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.98
|
| Rate for Payer: Clover Medicare Advantage |
$11.38
|
| Rate for Payer: EmblemHealth Commercial |
$35.94
|
| Rate for Payer: Humana Medicare Advantage |
$12.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
ANTG DET IMMUFL-PNEUMOCYSTIS
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87281
|
| Hospital Charge Code |
38477088
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
ANTG DET-IMMUNFL CYTOMEGALOVIR
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87271
|
| Hospital Charge Code |
38477080
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$36.50
|
| Rate for Payer: Aetna Medicare Advantage |
$43.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.68
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.42
|
| Rate for Payer: Clover Medicare Advantage |
$12.75
|
| Rate for Payer: EmblemHealth Commercial |
$40.26
|
| Rate for Payer: Humana Medicare Advantage |
$13.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
ANTG DET-IMMUNFL CYTOMEGALOVIR
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87271
|
| Hospital Charge Code |
38477080
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
ANTG DET IMMUNFL.LEGIONELLA PN
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87278
|
| Hospital Charge Code |
38477085
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
ANTG DET IMMUNFL.LEGIONELLA PN
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87278
|
| Hospital Charge Code |
38477085
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$42.43
|
| Rate for Payer: Aetna Medicare Advantage |
$50.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.59
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$15.60
|
| Rate for Payer: Clover Medicare Advantage |
$14.82
|
| Rate for Payer: EmblemHealth Commercial |
$46.80
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
ANTG.DET.IMMUNFL RESP SYNCYTIA
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87280
|
| Hospital Charge Code |
38477087
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
ANTG.DET.IMMUNFL RESP SYNCYTIA
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87280
|
| Hospital Charge Code |
38477087
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$36.50
|
| Rate for Payer: Aetna Medicare Advantage |
$43.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.68
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.42
|
| Rate for Payer: Clover Medicare Advantage |
$12.75
|
| Rate for Payer: EmblemHealth Commercial |
$40.26
|
| Rate for Payer: Humana Medicare Advantage |
$13.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
ANTG DET IMMUNFL VARICE ZOSTER
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87290
|
| Hospital Charge Code |
38477089
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$36.50
|
| Rate for Payer: Aetna Medicare Advantage |
$43.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.68
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.42
|
| Rate for Payer: Clover Medicare Advantage |
$12.75
|
| Rate for Payer: EmblemHealth Commercial |
$40.26
|
| Rate for Payer: Humana Medicare Advantage |
$13.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
ANTG DET IMMUNFL VARICE ZOSTER
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87290
|
| Hospital Charge Code |
38477089
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
ANTG.DET.IMMUN.PARAINFLUENZA
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87279
|
| Hospital Charge Code |
38477086
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
ANTG.DET.IMMUN.PARAINFLUENZA
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87279
|
| Hospital Charge Code |
38477086
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$44.69
|
| Rate for Payer: Aetna Medicare Advantage |
$53.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.60
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$16.43
|
| Rate for Payer: Clover Medicare Advantage |
$15.61
|
| Rate for Payer: EmblemHealth Commercial |
$49.29
|
| Rate for Payer: Humana Medicare Advantage |
$16.92
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
ANTG-D.IMMNFL-HERPES SIMPL VIR
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87273
|
| Hospital Charge Code |
38477081
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
ANTG-D.IMMNFL-HERPES SIMPL VIR
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87273
|
| Hospital Charge Code |
38477081
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Medicare Advantage |
$38.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.46
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$11.98
|
| Rate for Payer: Clover Medicare Advantage |
$11.38
|
| Rate for Payer: EmblemHealth Commercial |
$35.94
|
| Rate for Payer: Humana Medicare Advantage |
$12.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.58
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
ANTIB,HERPES SIMPLEX,TYPE 2
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
38476304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$156.00 |
| 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 |
$68.00
|
| 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 |
$35.36
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.40
|
| 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 |
$3.86
|
|
