|
PHENYTOIN SSP 100MG/4ML UD
|
Facility
|
OP
|
$57.89
|
|
|
Service Code
|
NDC 66689003601
|
| Hospital Charge Code |
60627741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: Aetna Medicare Advantage |
$17.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.76
|
| Rate for Payer: Cigna Commercial |
$28.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.05
|
| Rate for Payer: Oxford Commercial |
$11.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.64
|
|
|
PHENYTOIN SSP 100MG/4ML UD
|
Facility
|
IP
|
$57.89
|
|
|
Service Code
|
NDC 66689003601
|
| Hospital Charge Code |
60627741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.68
|
|
|
PH FECES
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
366883986
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna Medicare Advantage |
$11.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.99
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.58
|
| Rate for Payer: Clover Medicare Advantage |
$3.40
|
| Rate for Payer: EmblemHealth Commercial |
$10.74
|
| Rate for Payer: Humana Medicare Advantage |
$3.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.58
|
| 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 |
$2.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
PH FECES
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
39708031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
PH FECES
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
366883986
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
PH FECES
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
39708031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna Medicare Advantage |
$11.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.99
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.58
|
| Rate for Payer: Clover Medicare Advantage |
$3.40
|
| Rate for Payer: EmblemHealth Commercial |
$10.74
|
| Rate for Payer: Humana Medicare Advantage |
$3.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.58
|
| 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 |
$2.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
PH, FLUID
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
38473058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna Medicare Advantage |
$11.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.99
|
| Rate for Payer: Cigna Commercial |
$100.50
|
| Rate for Payer: Cigna Medicare Advantage |
$3.58
|
| Rate for Payer: Clover Medicare Advantage |
$3.40
|
| Rate for Payer: EmblemHealth Commercial |
$10.74
|
| Rate for Payer: Humana Medicare Advantage |
$3.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.26
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.71
|
|
|
PH, FLUID
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
38473058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$30.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.15
|
|
|
PHILADELPHIA CHROMOSOME
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
38474103
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$435.30 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.30
|
|
|
PHILADELPHIA CHROMOSOME
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
38474103
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$82.42 |
| Max. Negotiated Rate |
$1,451.00 |
| Rate for Payer: Aetna Commercial |
$341.33
|
| Rate for Payer: Aetna Medicare Advantage |
$406.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$455.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$455.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$455.21
|
| Rate for Payer: Cigna Commercial |
$1,451.00
|
| Rate for Payer: Cigna Medicare Advantage |
$125.49
|
| Rate for Payer: Clover Medicare Advantage |
$119.22
|
| Rate for Payer: EmblemHealth Commercial |
$376.47
|
| Rate for Payer: Humana Medicare Advantage |
$129.25
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$125.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$754.52
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$100.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$125.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$82.42
|
|
|
PHLEB VEINS - EXTREM 20+
|
Facility
|
IP
|
$17,623.95
|
|
|
Service Code
|
HCPCS 37766
|
| Hospital Charge Code |
421037766
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,643.59 |
| Max. Negotiated Rate |
$2,643.59 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,643.59
|
|
|
PHLEB VEINS - EXTREM 20+
|
Facility
|
OP
|
$17,623.95
|
|
|
Service Code
|
HCPCS 37766
|
| Hospital Charge Code |
421037766
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$466.40 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$466.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$3,751.17
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,582.23
|
| Rate for Payer: Oxford Commercial |
$3,524.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,643.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,524.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$556.92
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$500.52
|
|
|
PHOSPH ANTIB (IGG,IGA,IGM) PLA
|
Facility
|
OP
|
$80.35
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
401186148B
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$43.71
|
| Rate for Payer: Aetna Medicare Advantage |
$52.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.29
|
| Rate for Payer: Cigna Commercial |
$40.17
|
| Rate for Payer: Cigna Medicare Advantage |
$16.07
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.89
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.28
|
|
|
PHOSPH ANTIB (IGG,IGA,IGM) PLA
|
Facility
|
OP
|
$80.35
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
401186148D
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$43.71
|
| Rate for Payer: Aetna Medicare Advantage |
$52.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.29
|
| Rate for Payer: Cigna Commercial |
$40.17
|
| Rate for Payer: Cigna Medicare Advantage |
$16.07
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.89
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.28
|
|
|
PHOSPH ANTIB (IGG,IGA,IGM) PLA
|
Facility
|
IP
|
$80.35
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
401186148C
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.05
|
|
|
PHOSPH ANTIB (IGG,IGA,IGM) PLA
|
Facility
|
IP
|
$80.35
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
401186148D
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.05
|
|
|
PHOSPH ANTIB (IGG,IGA,IGM) PLA
|
Facility
|
OP
|
$80.35
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
401186148C
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$43.71
|
| Rate for Payer: Aetna Medicare Advantage |
$52.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.29
|
| Rate for Payer: Cigna Commercial |
$40.17
|
| Rate for Payer: Cigna Medicare Advantage |
$16.07
|
| Rate for Payer: Clover Medicare Advantage |
$15.27
|
| Rate for Payer: EmblemHealth Commercial |
$48.21
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.89
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.28
|
|
|
PHOSPH ANTIB (IGG,IGA,IGM) PLA
|
Facility
|
IP
|
$80.35
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
401186148B
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.05
|
|
|
PHOSPH ANTIBOD (IGG,IGA,IGM)
|
Facility
|
OP
|
$148.86
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
401383520D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.65
|
| Rate for Payer: Cigna Commercial |
$74.43
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.70
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.23
|
|
|
PHOSPH ANTIBOD (IGG,IGA,IGM)
|
Facility
|
OP
|
$148.86
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
401383520E
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.65
|
| Rate for Payer: Cigna Commercial |
$74.43
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.70
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.23
|
|
|
PHOSPH ANTIBOD (IGG,IGA,IGM)
|
Facility
|
IP
|
$148.86
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
401383520E
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$22.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.33
|
|
|
PHOSPH ANTIBOD (IGG,IGA,IGM)
|
Facility
|
IP
|
$148.86
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
401383520D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$22.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.33
|
|
|
PHOSPH ANTIBOD (IGG,IGA,IGM)
|
Facility
|
IP
|
$148.86
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
401383520F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$22.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.33
|
|
|
PHOSPH ANTIBOD (IGG,IGA,IGM)
|
Facility
|
OP
|
$148.86
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
401383520F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.65
|
| Rate for Payer: Cigna Commercial |
$74.43
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.70
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.23
|
|
|
PHOSPHATE24HR URINE WO CREATIN
|
Facility
|
OP
|
$65.24
|
|
|
Service Code
|
HCPCS 84105
|
| Hospital Charge Code |
401184105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare Advantage |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.97
|
| Rate for Payer: Cigna Commercial |
$32.62
|
| Rate for Payer: Cigna Medicare Advantage |
$5.78
|
| Rate for Payer: Clover Medicare Advantage |
$5.49
|
| Rate for Payer: EmblemHealth Commercial |
$17.34
|
| Rate for Payer: Humana Medicare Advantage |
$5.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.96
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.85
|
|
