|
PROTEIN, TOTAL, BLOOD
|
Facility
|
IP
|
$112.38
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3002268
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$16.86 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.86
|
|
|
PROTEIN, TOTAL, BODY FLUID
|
Facility
|
OP
|
$65.65
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3031176
|
|
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
|
|
|
PROTEIN, TOTAL, BODY FLUID
|
Facility
|
IP
|
$65.65
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3031176
|
|
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 BY REFRACT ANY S
|
Facility
|
IP
|
$36.64
|
|
|
Service Code
|
HCPCS 84160
|
| Hospital Charge Code |
38477040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
|
|
PROTEIN TOTAL BY REFRACT ANY S
|
Facility
|
OP
|
$36.64
|
|
|
Service Code
|
HCPCS 84160
|
| Hospital Charge Code |
38477040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$15.26
|
| Rate for Payer: Aetna Medicare Advantage |
$18.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.61
|
| 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 |
$20.25
|
| Rate for Payer: Cigna Commercial |
$18.32
|
| Rate for Payer: Cigna Medicare Advantage |
$5.61
|
| Rate for Payer: Clover Medicare Advantage |
$5.33
|
| Rate for Payer: EmblemHealth Commercial |
$16.83
|
| Rate for Payer: Humana Medicare Advantage |
$5.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.99
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.97
|
|
|
PROTEIN, TOTAL, CSF
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
3030020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| 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 |
$195.00
|
| 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 |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| 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 |
$10.34
|
|
|
PROTEIN, TOTAL, CSF
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
3030020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
PROTEIN,TOTAL CSF
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
38479008
|
|
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,TOTAL CSF
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
38479008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.40
|
|
|
PROTEIN,TOTAL,SYNOVIAL FL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
39990018EX
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| 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 |
$195.00
|
| 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 |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| 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 |
$10.34
|
|
|
PROTEIN,TOTAL,SYNOVIAL FL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
39990018EX
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
PROTEIN,TOTAL,SYNOVIAL FL I
|
Facility
|
IP
|
$25.20
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
39990018A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.78
|
|
|
PROTEIN,TOTAL,SYNOVIAL FL I
|
Facility
|
OP
|
$25.20
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
39990018A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.67 |
| 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 |
$12.60
|
| 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 |
$7.56
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.78
|
| 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 |
$0.67
|
|
|
PROTEIN,TOTAL,SYNOVIAL FL II
|
Facility
|
IP
|
$25.20
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
39990018B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.78
|
|
|
PROTEIN,TOTAL,SYNOVIAL FL II
|
Facility
|
OP
|
$25.20
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
39990018B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.67 |
| 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 |
$12.60
|
| 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 |
$7.56
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.78
|
| 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 |
$0.67
|
|
|
PROTEIN, TOTAL, URINE
|
Facility
|
OP
|
$61.70
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
3002243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.64 |
| 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 |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.25
|
| Rate for Payer: Cigna Commercial |
$30.85
|
| 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 |
$18.51
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.26
|
| 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 |
$1.64
|
|
|
PROTEIN, TOTAL, URINE
|
Facility
|
IP
|
$61.70
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
3002243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.26
|
|
|
PROTEIN WESTERN BLOT BODY FLUI
|
Facility
|
OP
|
$120.60
|
|
|
Service Code
|
HCPCS 84181
|
| Hospital Charge Code |
38477143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Aetna Medicare Advantage |
$55.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.47
|
| Rate for Payer: Cigna Commercial |
$60.30
|
| Rate for Payer: Cigna Medicare Advantage |
$17.03
|
| Rate for Payer: Clover Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$51.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.18
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.20
|
|
|
PROTEIN WESTERN BLOT BODY FLUI
|
Facility
|
IP
|
$120.60
|
|
|
Service Code
|
HCPCS 84181
|
| Hospital Charge Code |
38477143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.09 |
| Max. Negotiated Rate |
$18.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.09
|
|
|
PROTEIN WESTERN BLOT EACH(X6)
|
Facility
|
OP
|
$732.08
|
|
|
Service Code
|
HCPCS 84182
|
| Hospital Charge Code |
40119477A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$366.04 |
| Rate for Payer: Aetna Commercial |
$79.45
|
| Rate for Payer: Aetna Medicare Advantage |
$94.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.44
|
| Rate for Payer: Cigna Commercial |
$366.04
|
| Rate for Payer: Cigna Medicare Advantage |
$29.21
|
| Rate for Payer: Clover Medicare Advantage |
$27.75
|
| Rate for Payer: EmblemHealth Commercial |
$87.63
|
| Rate for Payer: Humana Medicare Advantage |
$30.09
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$29.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.40
|
|
|
PROTEIN WESTERN BLOT EACH(X6)
|
Facility
|
IP
|
$732.08
|
|
|
Service Code
|
HCPCS 84182
|
| Hospital Charge Code |
40119477A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.81 |
| Max. Negotiated Rate |
$109.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.81
|
|
|
PROT ELECTROPHORESIS,UR
|
Facility
|
IP
|
$126.30
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
38479109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.95
|
|
|
PROT ELECTROPHORESIS,UR
|
Facility
|
OP
|
$126.30
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
38479109
|
|
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
|
|
|
PROTHESIS PENILE AMBICOR 18 CM
|
Facility
|
OP
|
$69,625.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
270686106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,677.96 |
| Max. Negotiated Rate |
$34,812.50 |
| Rate for Payer: Aetna Commercial |
$26,457.50
|
| Rate for Payer: Aetna Medicare Advantage |
$20,887.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17,754.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17,754.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17,754.38
|
| Rate for Payer: Cigna Commercial |
$34,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,849.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$15,317.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10,443.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,677.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,845.06
|
|
|
PROTHESIS PENILE AMBICOR 18 CM
|
Facility
|
IP
|
$69,625.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
270686106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,443.75 |
| Max. Negotiated Rate |
$16,849.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13,925.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,849.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$15,317.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10,443.75
|
|
