|
DETECT BY NUC ACID GARDNERELLA
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 87510
|
| Hospital Charge Code |
38477161
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare Advantage |
$64.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.73
|
| Rate for Payer: Cigna Commercial |
$70.50
|
| Rate for Payer: Cigna Medicare Advantage |
$20.05
|
| Rate for Payer: Clover Medicare Advantage |
$19.05
|
| Rate for Payer: EmblemHealth Commercial |
$60.15
|
| Rate for Payer: Humana Medicare Advantage |
$20.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.66
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.00
|
|
|
DETECT BY NUC ACID GARDNERELLA
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 87510
|
| Hospital Charge Code |
38477161
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.15 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.15
|
|
|
DETECT BY NUC ACID MULT ORG AM
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
38477229
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.03 |
| Max. Negotiated Rate |
$254.65 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: Aetna Medicare Advantage |
$227.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$254.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$254.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$65.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$254.65
|
| Rate for Payer: Cigna Commercial |
$247.00
|
| Rate for Payer: Cigna Medicare Advantage |
$70.20
|
| Rate for Payer: Clover Medicare Advantage |
$66.69
|
| Rate for Payer: EmblemHealth Commercial |
$210.60
|
| Rate for Payer: Humana Medicare Advantage |
$72.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$70.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.44
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$56.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.03
|
|
|
DETECT BY NUC ACID MULT ORG AM
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
38477229
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.10
|
|
|
DETECT BY NUCL ACD CLOSTRIDIUM
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
38477193
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.05
|
|
|
DETECT BY NUCL ACD CLOSTRIDIUM
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
38477193
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$101.37
|
| Rate for Payer: Aetna Medicare Advantage |
$120.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$135.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$135.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$37.27
|
| 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 |
$135.20
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cigna Medicare Advantage |
$37.27
|
| Rate for Payer: Clover Medicare Advantage |
$35.41
|
| Rate for Payer: EmblemHealth Commercial |
$111.81
|
| Rate for Payer: Humana Medicare Advantage |
$38.39
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$37.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.22
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$37.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.01
|
|
|
DETECT BY NUCL ACD HEPATITIS B
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 87516
|
| Hospital Charge Code |
38477195
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.05
|
|
|
DETECT BY NUCL ACD HEPATITIS B
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 87516
|
| Hospital Charge Code |
38477195
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| 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 |
$127.29
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cigna Medicare Advantage |
$35.09
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.22
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.01
|
|
|
DETECT BY NUCLEIC ACD ENTEROV
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
38477194
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.05
|
|
|
DETECT BY NUCLEIC ACD ENTEROV
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
38477194
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.29
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cigna Medicare Advantage |
$35.09
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.22
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.01
|
|
|
DETECT BY NUCLEIC ACID CHLAMYD
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 87490
|
| Hospital Charge Code |
38477159
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.15 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.15
|
|
|
DETECT BY NUCLEIC ACID CHLAMYD
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 87490
|
| Hospital Charge Code |
38477159
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$61.88
|
| Rate for Payer: Aetna Medicare Advantage |
$73.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$42.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.53
|
| Rate for Payer: Cigna Commercial |
$70.50
|
| Rate for Payer: Cigna Medicare Advantage |
$22.75
|
| Rate for Payer: Clover Medicare Advantage |
$21.61
|
| Rate for Payer: EmblemHealth Commercial |
$68.25
|
| Rate for Payer: Humana Medicare Advantage |
$23.43
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.66
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.00
|
|
|
DETECT NUCLEIC ACID CANDIDA DI
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 87480
|
| Hospital Charge Code |
38477158
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare Advantage |
$64.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.73
|
| Rate for Payer: Cigna Commercial |
$70.50
|
| Rate for Payer: Cigna Medicare Advantage |
$20.05
|
| Rate for Payer: Clover Medicare Advantage |
$19.05
|
| Rate for Payer: EmblemHealth Commercial |
$60.15
|
| Rate for Payer: Humana Medicare Advantage |
$20.65
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.66
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.00
|
|
|
DETECT NUCLEIC ACID CANDIDA DI
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 87480
|
| Hospital Charge Code |
38477158
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.15 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.15
|
|
|
DETECTOR CO2 STATCO2 END TIDAL
|
Facility
|
OP
|
$71.84
|
|
| Hospital Charge Code |
270645180
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$35.92 |
| Rate for Payer: Aetna Commercial |
$27.30
|
| Rate for Payer: Aetna Medicare Advantage |
$21.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.32
|
| Rate for Payer: Cigna Commercial |
$35.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.68
|
| Rate for Payer: Oxford Commercial |
$14.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.37
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.04
|
|
|
DETECTOR CO2 STATCO2 END TIDAL
|
Facility
|
IP
|
$71.84
|
|
| Hospital Charge Code |
270645180
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.78
|
|
|
DETER HISTO/CYTOCHEM ID ENZYME
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 88319
|
| Hospital Charge Code |
38477184
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$3,472.13 |
| Rate for Payer: Aetna Commercial |
$2,603.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,101.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,472.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,472.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$957.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,472.13
|
| Rate for Payer: Cigna Commercial |
$1,918.64
|
| Rate for Payer: Cigna Medicare Advantage |
$957.17
|
| Rate for Payer: Clover Medicare Advantage |
$909.31
|
| Rate for Payer: EmblemHealth Commercial |
$2,871.51
|
| Rate for Payer: Humana Medicare Advantage |
$985.89
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$957.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.42
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$111.97
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$957.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$957.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.16
|
|
|
DETER HISTO/CYTOCHEM ID ENZYME
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 88319
|
| Hospital Charge Code |
38477184
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.55
|
|
|
DETET BY IMMUN OPTICAL OBV INF
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87804
|
| Hospital Charge Code |
38477099
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$45.02
|
| Rate for Payer: Aetna Medicare Advantage |
$53.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.55
|
| 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 |
$60.04
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$16.55
|
| Rate for Payer: Clover Medicare Advantage |
$15.72
|
| Rate for Payer: EmblemHealth Commercial |
$49.65
|
| Rate for Payer: Humana Medicare Advantage |
$17.05
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.55
|
| 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 |
$13.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
DETET BY IMMUN OPTICAL OBV INF
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87804
|
| Hospital Charge Code |
38477099
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
DET IMMUNASSY OPTICAL OBV RSV
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
38477100
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
|
|
DET IMMUNASSY OPTICAL OBV RSV
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
38477100
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$35.63
|
| Rate for Payer: Aetna Medicare Advantage |
$42.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.52
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$13.10
|
| Rate for Payer: Clover Medicare Advantage |
$12.45
|
| Rate for Payer: EmblemHealth Commercial |
$39.30
|
| Rate for Payer: Humana Medicare Advantage |
$13.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.10
|
| 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 |
$10.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
DET NUC ACD MYCOBACT AVIUM INT
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 87560
|
| Hospital Charge Code |
38477163
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$74.23
|
| Rate for Payer: Aetna Medicare Advantage |
$88.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$98.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$98.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$27.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$98.99
|
| Rate for Payer: Cigna Commercial |
$70.50
|
| Rate for Payer: Cigna Medicare Advantage |
$27.29
|
| Rate for Payer: Clover Medicare Advantage |
$25.93
|
| Rate for Payer: EmblemHealth Commercial |
$81.87
|
| Rate for Payer: Humana Medicare Advantage |
$28.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$27.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.66
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$27.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.00
|
|
|
DET NUC ACD MYCOBACT AVIUM INT
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 87560
|
| Hospital Charge Code |
38477163
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.15 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.15
|
|
|
DET NUC ACD NEISSERIA GONORRHO
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 87590
|
| Hospital Charge Code |
38477164
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$73.11
|
| Rate for Payer: Aetna Medicare Advantage |
$87.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$42.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.51
|
| Rate for Payer: Cigna Commercial |
$70.50
|
| Rate for Payer: Cigna Medicare Advantage |
$26.88
|
| Rate for Payer: Clover Medicare Advantage |
$25.54
|
| Rate for Payer: EmblemHealth Commercial |
$80.64
|
| Rate for Payer: Humana Medicare Advantage |
$27.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$26.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.66
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.00
|
|
