|
MYCOBAC PCR,C/SM,NON-RESP I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
3990156A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$18.17
|
| Rate for Payer: Aetna Medicare Advantage |
$21.64
|
| 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) Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.23
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.68
|
| Rate for Payer: Clover Medicare Advantage |
$6.35
|
| Rate for Payer: EmblemHealth Commercial |
$20.04
|
| Rate for Payer: Humana Medicare Advantage |
$6.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.68
|
| 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 |
$5.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
MYCOBAC PCR,C/SM,NON-RESP II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
3990156B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Medicare Advantage |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.18
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.80
|
| Rate for Payer: Clover Medicare Advantage |
$10.26
|
| Rate for Payer: EmblemHealth Commercial |
$32.40
|
| Rate for Payer: Humana Medicare Advantage |
$11.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.80
|
| 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 |
$8.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
MYCOBAC PCR,C/SM,NON-RESP II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
3990156B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
MYCOBAC PCR,C/SM,NON-RESP III
|
Facility
|
IP
|
$36.70
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
3990156C
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
MYCOBAC PCR,C/SM,NON-RESP III
|
Facility
|
OP
|
$36.70
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
3990156C
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Medicare Advantage |
$17.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.55
|
| Rate for Payer: Cigna Commercial |
$18.35
|
| Rate for Payer: Cigna Medicare Advantage |
$5.39
|
| Rate for Payer: Clover Medicare Advantage |
$5.12
|
| Rate for Payer: EmblemHealth Commercial |
$16.17
|
| Rate for Payer: Humana Medicare Advantage |
$5.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.54
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.04
|
|
|
MYCOBAC PCR,C/SM,NON-RESP IV
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
3990156D
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$113.37
|
| Rate for Payer: Aetna Medicare Advantage |
$135.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$151.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$151.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$41.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$32.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$151.19
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$41.68
|
| Rate for Payer: Clover Medicare Advantage |
$39.60
|
| Rate for Payer: EmblemHealth Commercial |
$125.04
|
| Rate for Payer: Humana Medicare Advantage |
$42.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$41.68
|
| 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 |
$33.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$41.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
MYCOBAC PCR,C/SM,NON-RESP IV
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
3990156D
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
MYCOBACTERIA CULT,CSF I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
39990153A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
MYCOBACTERIA CULT,CSF I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
39990153A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$18.17
|
| Rate for Payer: Aetna Medicare Advantage |
$21.64
|
| 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) Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.23
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.68
|
| Rate for Payer: Clover Medicare Advantage |
$6.35
|
| Rate for Payer: EmblemHealth Commercial |
$20.04
|
| Rate for Payer: Humana Medicare Advantage |
$6.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.68
|
| 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 |
$5.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
MYCOBACTERIA CULT,CSF II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
39990153B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
MYCOBACTERIA CULT,CSF II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
39990153B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Medicare Advantage |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.18
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.80
|
| Rate for Payer: Clover Medicare Advantage |
$10.26
|
| Rate for Payer: EmblemHealth Commercial |
$32.40
|
| Rate for Payer: Humana Medicare Advantage |
$11.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.80
|
| 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 |
$8.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
MYCOBACTERIA CULT,CSF III
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
39990153C
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Medicare Advantage |
$17.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.55
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.39
|
| Rate for Payer: Clover Medicare Advantage |
$5.12
|
| Rate for Payer: EmblemHealth Commercial |
$16.17
|
| Rate for Payer: Humana Medicare Advantage |
$5.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.39
|
| 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 |
$4.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
MYCOBACTERIA CULT,CSF III
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
39990153C
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
MYCOBACTERIA CULT,GASTRIC I
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
39990152A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$18.17
|
| Rate for Payer: Aetna Medicare Advantage |
$21.64
|
| 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) Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.23
|
| Rate for Payer: Cigna Commercial |
$22.95
|
| Rate for Payer: Cigna Medicare Advantage |
$6.68
|
| Rate for Payer: Clover Medicare Advantage |
$6.35
|
| Rate for Payer: EmblemHealth Commercial |
$20.04
|
| Rate for Payer: Humana Medicare Advantage |
$6.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.93
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.30
|
|
|
MYCOBACTERIA CULT,GASTRIC I
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
39990152A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.88
|
|
|
MYCOBACTERIA CULT,GASTRIC II
|
Facility
|
IP
|
$73.70
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
39990152B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.05
|
|
|
MYCOBACTERIA CULT,GASTRIC II
|
Facility
|
OP
|
$73.70
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
39990152B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Medicare Advantage |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.18
|
| Rate for Payer: Cigna Commercial |
$36.85
|
| Rate for Payer: Cigna Medicare Advantage |
$10.80
|
| Rate for Payer: Clover Medicare Advantage |
$10.26
|
| Rate for Payer: EmblemHealth Commercial |
$32.40
|
| Rate for Payer: Humana Medicare Advantage |
$11.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.16
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.09
|
|
|
MYCOBACTERIA CULT,GASTRIC III
|
Facility
|
IP
|
$36.70
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
39990152C
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
MYCOBACTERIA CULT,GASTRIC III
|
Facility
|
OP
|
$36.70
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
39990152C
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Medicare Advantage |
$17.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.55
|
| Rate for Payer: Cigna Commercial |
$18.35
|
| Rate for Payer: Cigna Medicare Advantage |
$5.39
|
| Rate for Payer: Clover Medicare Advantage |
$5.12
|
| Rate for Payer: EmblemHealth Commercial |
$16.17
|
| Rate for Payer: Humana Medicare Advantage |
$5.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.54
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.04
|
|
|
MYCOBACTERIA CULT + STAIN I
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
39990151A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
MYCOBACTERIA CULT + STAIN I
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
39990151A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$18.17
|
| Rate for Payer: Aetna Medicare Advantage |
$21.64
|
| 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) Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.23
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$6.68
|
| Rate for Payer: Clover Medicare Advantage |
$6.35
|
| Rate for Payer: EmblemHealth Commercial |
$20.04
|
| Rate for Payer: Humana Medicare Advantage |
$6.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.57
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
MYCOBACTERIA CULT + STAIN II
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
39990151B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
MYCOBACTERIA CULT + STAIN II
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
39990151B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Medicare Advantage |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.18
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$10.80
|
| Rate for Payer: Clover Medicare Advantage |
$10.26
|
| Rate for Payer: EmblemHealth Commercial |
$32.40
|
| Rate for Payer: Humana Medicare Advantage |
$11.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.57
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
MYCOBACTERIA CULT + STAIN III
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
39990151C
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
MYCOBACTERIA CULT + STAIN III
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
39990151C
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Medicare Advantage |
$17.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.55
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$5.39
|
| Rate for Payer: Clover Medicare Advantage |
$5.12
|
| Rate for Payer: EmblemHealth Commercial |
$16.17
|
| Rate for Payer: Humana Medicare Advantage |
$5.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.57
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
