|
PROTEIN C,ACTIVITY
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
39900166
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PROTEIN C ANTIGEN
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 85302
|
| Hospital Charge Code |
3007655
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.67
|
| Rate for Payer: Aetna Medicare Advantage |
$38.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.35
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.01
|
| Rate for Payer: Clover Medicare Advantage |
$11.41
|
| Rate for Payer: EmblemHealth Commercial |
$36.03
|
| Rate for Payer: Humana Medicare Advantage |
$12.37
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
|
PROTEIN C ANTIGEN
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 85302
|
| Hospital Charge Code |
3007655
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
PROTEIN C,ANTIGENIC
|
Facility
|
OP
|
$82.60
|
|
|
Service Code
|
HCPCS 85302
|
| Hospital Charge Code |
39900165
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$32.67
|
| Rate for Payer: Aetna Medicare Advantage |
$38.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.35
|
| Rate for Payer: Cigna Commercial |
$41.30
|
| Rate for Payer: Cigna Medicare Advantage |
$12.01
|
| Rate for Payer: Clover Medicare Advantage |
$11.41
|
| Rate for Payer: EmblemHealth Commercial |
$36.03
|
| Rate for Payer: Humana Medicare Advantage |
$12.37
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.78
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
PROTEIN C,ANTIGENIC
|
Facility
|
IP
|
$82.60
|
|
|
Service Code
|
HCPCS 85302
|
| Hospital Charge Code |
39900165
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$12.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.39
|
|
|
PROTEIN C,FUNCTIONAL
|
Facility
|
IP
|
$95.05
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
39900167
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$14.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.26
|
|
|
PROTEIN C,FUNCTIONAL
|
Facility
|
OP
|
$95.05
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
39900167
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$37.64
|
| Rate for Payer: Aetna Medicare Advantage |
$44.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.96
|
| Rate for Payer: Cigna Commercial |
$47.52
|
| Rate for Payer: Cigna Medicare Advantage |
$13.84
|
| Rate for Payer: Clover Medicare Advantage |
$13.15
|
| Rate for Payer: EmblemHealth Commercial |
$41.52
|
| Rate for Payer: Humana Medicare Advantage |
$14.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.52
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.52
|
|
|
PROTEIN, CSF***
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3002235
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.85
|
|
|
PROTEIN, CSF***
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3002235
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$9.98
|
| Rate for Payer: Aetna Medicare Advantage |
$11.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.25
|
| Rate for Payer: Cigna Commercial |
$9.50
|
| Rate for Payer: Cigna Medicare Advantage |
$3.67
|
| Rate for Payer: Clover Medicare Advantage |
$3.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.01
|
| Rate for Payer: Humana Medicare Advantage |
$3.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.94
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.50
|
|
|
PROTEIN ELECTROPHORESIS***
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
3012226
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.15
|
|
|
PROTEIN ELECTROPHORESIS***
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
3012226
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$15.58
|
| Rate for Payer: Aetna Medicare Advantage |
$12.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.46
|
| Rate for Payer: Cigna Commercial |
$20.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.30
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.09
|
|
|
PROTEIN ELECTROPHORESIS CSF
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3002222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$29.21
|
| Rate for Payer: Aetna Medicare Advantage |
$34.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.77
|
| Rate for Payer: Cigna Commercial |
$44.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.74
|
| Rate for Payer: Clover Medicare Advantage |
$10.20
|
| Rate for Payer: EmblemHealth Commercial |
$32.22
|
| Rate for Payer: Humana Medicare Advantage |
$11.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.33
|
|
|
PROTEIN ELECTROPHORESIS CSF
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3002222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.20
|
|
|
PROTEIN ELECTROPHORESIS, CSF
|
Facility
|
OP
|
$126.30
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
38472581
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.50
|
| Rate for Payer: Aetna Medicare Advantage |
$57.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.36
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Cigna Medicare Advantage |
$17.83
|
| Rate for Payer: Clover Medicare Advantage |
$16.94
|
| Rate for Payer: EmblemHealth Commercial |
$53.49
|
| Rate for Payer: Humana Medicare Advantage |
$18.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.89
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.35
|
|
|
PROTEIN ELECTROPHORESIS, CSF
|
Facility
|
IP
|
$126.30
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
38472581
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.95
|
|
|
PROTEIN ELECTROPHORESIS,SR
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
38472575
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$29.21
|
| Rate for Payer: Aetna Medicare Advantage |
$34.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.77
|
| Rate for Payer: Cigna Commercial |
$78.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.74
|
| Rate for Payer: Clover Medicare Advantage |
$10.20
|
| Rate for Payer: EmblemHealth Commercial |
$32.22
|
| Rate for Payer: Humana Medicare Advantage |
$11.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.13
|
|
|
PROTEIN ELECTROPHORESIS,SR
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
38472575
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.40
|
|
|
PROTEIN ELECTROPHORESIS URINE
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3009982
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.20
|
|
|
PROTEIN ELECTROPHORESIS URINE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3009982
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$29.21
|
| Rate for Payer: Aetna Medicare Advantage |
$34.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.77
|
| Rate for Payer: Cigna Commercial |
$44.00
|
| Rate for Payer: Cigna Medicare Advantage |
$10.74
|
| Rate for Payer: Clover Medicare Advantage |
$10.20
|
| Rate for Payer: EmblemHealth Commercial |
$32.22
|
| Rate for Payer: Humana Medicare Advantage |
$11.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$10.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.33
|
|
|
PROTEIN ELECTROPHORESIS, URINE
|
Facility
|
OP
|
$126.30
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
38472578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$48.50
|
| Rate for Payer: Aetna Medicare Advantage |
$57.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.36
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Cigna Medicare Advantage |
$17.83
|
| Rate for Payer: Clover Medicare Advantage |
$16.94
|
| Rate for Payer: EmblemHealth Commercial |
$53.49
|
| Rate for Payer: Humana Medicare Advantage |
$18.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.89
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.35
|
|
|
PROTEIN ELECTROPHORESIS, URINE
|
Facility
|
IP
|
$126.30
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
38472578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.95
|
|
|
PROTEIN,FLUID
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
38479017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.40
|
|
|
PROTEIN,FLUID
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
38479017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$15,880.57 |
| Rate for Payer: Aetna Commercial |
$10.88
|
| Rate for Payer: Aetna Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.44
|
| Rate for Payer: Cigna Commercial |
$58.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.00
|
| Rate for Payer: Clover Medicare Advantage |
$3.80
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Humana Medicare Advantage |
$4.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.20
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$15,880.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.07
|
|
|
PROTEIN IMMUNOELECTROPHORESIS
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
38472713
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$60.76
|
| Rate for Payer: Aetna Medicare Advantage |
$72.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$80.64
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Cigna Medicare Advantage |
$22.34
|
| Rate for Payer: Clover Medicare Advantage |
$21.22
|
| Rate for Payer: EmblemHealth Commercial |
$67.02
|
| Rate for Payer: Humana Medicare Advantage |
$23.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.63
|
|
|
PROTEIN IMMUNOELECTROPHORESIS
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
38472713
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.80
|
|
