|
PROTEIN MATRIX
|
Facility
|
OP
|
$15,000.00
|
|
| Hospital Charge Code |
270703279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$5,700.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,825.00
|
| Rate for Payer: Cigna Commercial |
$7,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,630.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,250.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$361.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$397.50
|
|
|
PROTEIN MATRIX
|
Facility
|
IP
|
$15,000.00
|
|
| Hospital Charge Code |
270703279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,250.00 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,630.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,250.00
|
|
|
PROTEIN MATRIX 10CC
|
Facility
|
IP
|
$15,000.00
|
|
| Hospital Charge Code |
270703017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,250.00 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,630.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,250.00
|
|
|
PROTEIN MATRIX 10CC
|
Facility
|
OP
|
$15,000.00
|
|
| Hospital Charge Code |
270703017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$5,700.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,825.00
|
| Rate for Payer: Cigna Commercial |
$7,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,630.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,250.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$361.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$397.50
|
|
|
PROTEIN S
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
38473076
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: Aetna Commercial |
$31.58
|
| Rate for Payer: Aetna Medicare Advantage |
$37.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.91
|
| Rate for Payer: Cigna Commercial |
$205.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.61
|
| Rate for Payer: Clover Medicare Advantage |
$11.03
|
| Rate for Payer: EmblemHealth Commercial |
$34.83
|
| Rate for Payer: Humana Medicare Advantage |
$11.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$123.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.87
|
|
|
PROTEIN S
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
38473076
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.50
|
|
|
PROTEIN S, ACTIVITY
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
3035127
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$8.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.06
|
|
|
PROTEIN S, ACTIVITY
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
3035127
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$41.67
|
| Rate for Payer: Aetna Medicare Advantage |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.32
|
| 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 |
$55.30
|
| Rate for Payer: Cigna Commercial |
$26.88
|
| Rate for Payer: Cigna Medicare Advantage |
$15.32
|
| Rate for Payer: Clover Medicare Advantage |
$14.55
|
| Rate for Payer: EmblemHealth Commercial |
$45.96
|
| Rate for Payer: Humana Medicare Advantage |
$15.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.12
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.42
|
|
|
PROTEIN S,ACTIVITY
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
39900169
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$41.67
|
| Rate for Payer: Aetna Medicare Advantage |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.32
|
| 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 |
$55.30
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$15.32
|
| Rate for Payer: Clover Medicare Advantage |
$14.55
|
| Rate for Payer: EmblemHealth Commercial |
$45.96
|
| Rate for Payer: Humana Medicare Advantage |
$15.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.28
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
PROTEIN S,ACTIVITY
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
39900169
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PROTEIN S,ANTIGENIC
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
39900168
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$31.58
|
| Rate for Payer: Aetna Medicare Advantage |
$37.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.91
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$11.61
|
| Rate for Payer: Clover Medicare Advantage |
$11.03
|
| Rate for Payer: EmblemHealth Commercial |
$34.83
|
| Rate for Payer: Humana Medicare Advantage |
$11.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.28
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.69
|
|
|
PROTEIN S,ANTIGENIC
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
39900168
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
PROTEIN, SERUM PANEL***
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3002268P
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
|
|
PROTEIN, SERUM PANEL***
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3002268P
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.19 |
| 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 |
$3.60
|
| 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 |
$2.16
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
| 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 |
$0.19
|
|
|
PROTEIN S,FUNCTIONAL
|
Facility
|
OP
|
$105.30
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
39900170
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$41.67
|
| Rate for Payer: Aetna Medicare Advantage |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.32
|
| 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 |
$55.30
|
| Rate for Payer: Cigna Commercial |
$52.65
|
| Rate for Payer: Cigna Medicare Advantage |
$15.32
|
| Rate for Payer: Clover Medicare Advantage |
$14.55
|
| Rate for Payer: EmblemHealth Commercial |
$45.96
|
| Rate for Payer: Humana Medicare Advantage |
$15.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.59
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.79
|
|
|
PROTEIN S,FUNCTIONAL
|
Facility
|
IP
|
$105.30
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
39900170
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.79
|
|
|
PROTEIN S I
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
3038085A
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
PROTEIN S I
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
3038085A
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$31.58
|
| Rate for Payer: Aetna Medicare Advantage |
$37.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.91
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.61
|
| Rate for Payer: Clover Medicare Advantage |
$11.03
|
| Rate for Payer: EmblemHealth Commercial |
$34.83
|
| Rate for Payer: Humana Medicare Advantage |
$11.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.61
|
| 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 |
$9.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
|
PROTEIN S II
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
3038085B
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$8.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.06
|
|
|
PROTEIN S II
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
3038085B
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$41.67
|
| Rate for Payer: Aetna Medicare Advantage |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.32
|
| 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 |
$55.30
|
| Rate for Payer: Cigna Commercial |
$26.88
|
| Rate for Payer: Cigna Medicare Advantage |
$15.32
|
| Rate for Payer: Clover Medicare Advantage |
$14.55
|
| Rate for Payer: EmblemHealth Commercial |
$45.96
|
| Rate for Payer: Humana Medicare Advantage |
$15.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.12
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.42
|
|
|
PROTEIN S TOTAL (PLASMA)
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
3007663
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$31.58
|
| Rate for Payer: Aetna Medicare Advantage |
$37.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.91
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: Cigna Medicare Advantage |
$11.61
|
| Rate for Payer: Clover Medicare Advantage |
$11.03
|
| Rate for Payer: EmblemHealth Commercial |
$34.83
|
| Rate for Payer: Humana Medicare Advantage |
$11.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.61
|
| 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 |
$9.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.39
|
|
|
PROTEIN S TOTAL (PLASMA)
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
3007663
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
PROTEIN, TOTAL, BLOOD
|
Facility
|
OP
|
$112.38
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3002268
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| 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 |
$56.19
|
| 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 |
$33.71
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.86
|
| 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 |
$2.98
|
|
|
PROTEIN, TOTAL, BLOOD
|
Facility
|
IP
|
$65.65
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3002227C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
PROTEIN, TOTAL, BLOOD
|
Facility
|
OP
|
$65.65
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3002227C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.74 |
| 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 |
$32.83
|
| 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 |
$19.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
| 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 |
$1.74
|
|
