|
RUBELLA AB, IGG
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
38476032
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$87.45 |
| Max. Negotiated Rate |
$87.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.45
|
|
|
RUBELLA AB, IGG
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
38476032
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$291.50 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare Advantage |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.39
|
| 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 |
$52.20
|
| Rate for Payer: Cigna Commercial |
$291.50
|
| Rate for Payer: Cigna Medicare Advantage |
$14.39
|
| Rate for Payer: Clover Medicare Advantage |
$13.67
|
| Rate for Payer: EmblemHealth Commercial |
$43.17
|
| Rate for Payer: Humana Medicare Advantage |
$14.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$151.58
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.56
|
|
|
RUBELLA AB,IGG
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
38479080
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.75
|
|
|
RUBELLA AB,IGG
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
38479080
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$232.50 |
| 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 |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.72
|
| Rate for Payer: Cigna Commercial |
$232.50
|
| 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 |
$120.90
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.75
|
| 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 |
$13.21
|
|
|
RUBELLA AB (IGM)
|
Facility
|
IP
|
$98.95
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
39900252
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$14.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.84
|
|
|
RUBELLA AB (IGM)
|
Facility
|
OP
|
$98.95
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
39900252
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare Advantage |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.39
|
| 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 |
$52.20
|
| Rate for Payer: Cigna Commercial |
$49.48
|
| Rate for Payer: Cigna Medicare Advantage |
$14.39
|
| Rate for Payer: Clover Medicare Advantage |
$13.67
|
| Rate for Payer: EmblemHealth Commercial |
$43.17
|
| Rate for Payer: Humana Medicare Advantage |
$14.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.73
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.81
|
|
|
RUBELLA AB,IGM
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
38479125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare Advantage |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.39
|
| 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 |
$52.20
|
| Rate for Payer: Cigna Commercial |
$154.50
|
| Rate for Payer: Cigna Medicare Advantage |
$14.39
|
| Rate for Payer: Clover Medicare Advantage |
$13.67
|
| Rate for Payer: EmblemHealth Commercial |
$43.17
|
| Rate for Payer: Humana Medicare Advantage |
$14.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.34
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.78
|
|
|
RUBELLA AB,IGM
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
38476033
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$56.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.85
|
|
|
RUBELLA AB,IGM
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
38476033
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$189.50 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare Advantage |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.39
|
| 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 |
$52.20
|
| Rate for Payer: Cigna Commercial |
$189.50
|
| Rate for Payer: Cigna Medicare Advantage |
$14.39
|
| Rate for Payer: Clover Medicare Advantage |
$13.67
|
| Rate for Payer: EmblemHealth Commercial |
$43.17
|
| Rate for Payer: Humana Medicare Advantage |
$14.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.54
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.76
|
|
|
RUBELLA AB,IGM
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
38479125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.35 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.35
|
|
|
Rubella Antibodies, IgG
|
Facility
|
IP
|
$98.95
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
39888007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$14.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.84
|
|
|
Rubella Antibodies, IgG
|
Facility
|
OP
|
$98.95
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
39888007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare Advantage |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.39
|
| 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 |
$52.20
|
| Rate for Payer: Cigna Commercial |
$49.48
|
| Rate for Payer: Cigna Medicare Advantage |
$14.39
|
| Rate for Payer: Clover Medicare Advantage |
$13.67
|
| Rate for Payer: EmblemHealth Commercial |
$43.17
|
| Rate for Payer: Humana Medicare Advantage |
$14.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.73
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.81
|
|
|
RUBELLA IGG
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
39900385
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare Advantage |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.39
|
| 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 |
$52.20
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.39
|
| Rate for Payer: Clover Medicare Advantage |
$13.67
|
| Rate for Payer: EmblemHealth Commercial |
$43.17
|
| Rate for Payer: Humana Medicare Advantage |
$14.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.39
|
| 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 |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
RUBELLA IGG
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
39900385
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
RUBELLA IMMUNITY
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
38476030
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$71.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.70
|
|
|
RUBELLA IMMUNITY
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
38476030
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare Advantage |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.39
|
| 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 |
$52.20
|
| Rate for Payer: Cigna Commercial |
$239.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.39
|
| Rate for Payer: Clover Medicare Advantage |
$13.67
|
| Rate for Payer: EmblemHealth Commercial |
$43.17
|
| Rate for Payer: Humana Medicare Advantage |
$14.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$124.28
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.58
|
|
|
RUBELLA VIRUS VACCINE INJ
|
Facility
|
OP
|
$152.96
|
|
|
Service Code
|
NDC 6467300
|
| Hospital Charge Code |
60628310
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$76.48 |
| Rate for Payer: Aetna Commercial |
$58.12
|
| Rate for Payer: Aetna Medicare Advantage |
$45.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.00
|
| Rate for Payer: Cigna Commercial |
$76.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.77
|
| Rate for Payer: Oxford Commercial |
$30.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.34
|
|
|
RUBELLA VIRUS VACCINE INJ
|
Facility
|
IP
|
$152.96
|
|
|
Service Code
|
NDC 6467300
|
| Hospital Charge Code |
60628310
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$22.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.94
|
|
|
RUBEOLA AB, CF
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
38476038
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.30 |
| Max. Negotiated Rate |
$45.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.30
|
|
|
RUBEOLA AB, CF
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
38476038
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$156.00 |
| 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 |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.72
|
| Rate for Payer: Cigna Commercial |
$151.00
|
| 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 |
$78.52
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.30
|
| 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 |
$8.58
|
|
|
RUBEOLA AB (IGG),EIA
|
Facility
|
IP
|
$66.50
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
39900253
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.97
|
|
|
RUBEOLA AB (IGG),EIA
|
Facility
|
OP
|
$66.50
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
39900253
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$156.00 |
| 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 |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.72
|
| Rate for Payer: Cigna Commercial |
$33.25
|
| 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 |
$17.29
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.97
|
| 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 |
$1.89
|
|
|
RUBEOLA ANTIBODIES, IGM
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
38476140
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$46.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.65
|
|
|
RUBEOLA ANTIBODIES, IGM
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
38476140
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$156.00 |
| 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 |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.72
|
| Rate for Payer: Cigna Commercial |
$155.50
|
| 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 |
$80.86
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.65
|
| 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 |
$8.83
|
|
|
RUBEOLA IGG
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
38476037
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.75
|
|
