|
POLY VI SOL DROP
|
Facility
|
OP
|
$0.66
|
|
| Hospital Charge Code |
6063943268
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Aetna Commercial |
$0.25
|
| Rate for Payer: Aetna Medicare Advantage |
$0.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.17
|
| Rate for Payer: Cigna Commercial |
$0.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.17
|
| Rate for Payer: Oxford Commercial |
$0.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.13
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.02
|
|
|
POLY VI SOL DROP
|
Facility
|
IP
|
$0.66
|
|
| Hospital Charge Code |
6063943268
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.10
|
|
|
POLY VI SOL DROP
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 536845080
|
| Hospital Charge Code |
6063943231
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
POLY VI SOL DROP
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 536845080
|
| Hospital Charge Code |
6063943231
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.04
|
| Rate for Payer: Oxford Commercial |
$0.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.11
|
|
|
POOLING CHARGE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86965
|
| Hospital Charge Code |
3100519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
POOLING CHARGE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86965
|
| Hospital Charge Code |
3100519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$734.21 |
| Rate for Payer: Aetna Commercial |
$550.53
|
| Rate for Payer: Aetna Medicare Advantage |
$655.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$734.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$734.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$734.21
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$202.40
|
| Rate for Payer: Clover Medicare Advantage |
$192.28
|
| Rate for Payer: EmblemHealth Commercial |
$607.20
|
| Rate for Payer: Humana Medicare Advantage |
$208.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$202.40
|
| 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 |
$25.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
POOLING OF PLATELETS OR BLOOD
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86965
|
| Hospital Charge Code |
38471081
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$734.21 |
| Rate for Payer: Aetna Commercial |
$550.53
|
| Rate for Payer: Aetna Medicare Advantage |
$655.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$734.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$734.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$734.21
|
| Rate for Payer: Cigna Commercial |
$405.73
|
| Rate for Payer: Cigna Medicare Advantage |
$202.40
|
| Rate for Payer: Clover Medicare Advantage |
$192.28
|
| Rate for Payer: EmblemHealth Commercial |
$607.20
|
| Rate for Payer: Humana Medicare Advantage |
$208.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$202.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.74
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.23
|
|
|
POOLING OF PLATELETS OR BLOOD
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86965
|
| Hospital Charge Code |
38471081
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$22.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.35
|
|
|
PORACTANT ALFA 80 MG/ML(3ML)
|
Facility
|
OP
|
$9,495.91
|
|
|
Service Code
|
NDC 10122051003
|
| Hospital Charge Code |
6063943233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$269.68 |
| Max. Negotiated Rate |
$4,747.95 |
| Rate for Payer: Aetna Commercial |
$3,608.45
|
| Rate for Payer: Aetna Medicare Advantage |
$2,848.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,421.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,421.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,421.46
|
| Rate for Payer: Cigna Commercial |
$4,747.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,468.94
|
| Rate for Payer: Oxford Commercial |
$1,899.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,424.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,899.18
|
| Rate for Payer: UnitedHealthcare Community & State |
$300.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.68
|
|
|
PORACTANT ALFA 80 MG/ML(3ML)
|
Facility
|
IP
|
$9,495.91
|
|
|
Service Code
|
NDC 10122051003
|
| Hospital Charge Code |
6063943233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,424.39 |
| Max. Negotiated Rate |
$1,424.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,424.39
|
|
|
POROUS COATED INTERBODY 10X27X
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$7,600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,100.00
|
| Rate for Payer: Cigna Commercial |
$10,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,840.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$632.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$568.00
|
|
|
POROUS COATED INTERBODY 10X27X
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$4,840.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,840.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
|
|
POROUS IM STEM 15.5X150
|
Facility
|
IP
|
$11,820.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270673873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.00 |
| Max. Negotiated Rate |
$2,860.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,364.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,860.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,773.00
|
|
|
POROUS IM STEM 15.5X150
|
Facility
|
OP
|
$11,820.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270673873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$335.69 |
| Max. Negotiated Rate |
$5,910.00 |
| Rate for Payer: Aetna Commercial |
$4,491.60
|
| Rate for Payer: Aetna Medicare Advantage |
$3,546.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,014.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,014.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,364.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,014.10
|
| Rate for Payer: Cigna Commercial |
$5,910.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,860.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,773.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$373.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$335.69
|
|
|
PORPHOBILINOGEN,24HR
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
38479121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
|
|
PORPHOBILINOGEN,24HR
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
38479121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$22.96
|
| Rate for Payer: Aetna Medicare Advantage |
$27.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.62
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: Cigna Medicare Advantage |
$8.44
|
| Rate for Payer: Clover Medicare Advantage |
$8.02
|
| Rate for Payer: EmblemHealth Commercial |
$25.32
|
| Rate for Payer: Humana Medicare Advantage |
$8.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.10
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.41
|
|
|
PORPHOBILINOGEN, URINE
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 84106
|
| Hospital Charge Code |
38472545
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
|
|
PORPHOBILINOGEN, URINE
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 84106
|
| Hospital Charge Code |
38472545
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$15.83
|
| Rate for Payer: Aetna Medicare Advantage |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.11
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: Cigna Medicare Advantage |
$5.82
|
| Rate for Payer: Clover Medicare Advantage |
$5.53
|
| Rate for Payer: EmblemHealth Commercial |
$17.46
|
| Rate for Payer: Humana Medicare Advantage |
$5.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.10
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.41
|
|
|
PORPHOBILINOGEN,URINE I
|
Facility
|
IP
|
$29.40
|
|
|
Service Code
|
HCPCS 84106
|
| Hospital Charge Code |
39990017A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.41
|
|
|
PORPHOBILINOGEN,URINE I
|
Facility
|
OP
|
$29.40
|
|
|
Service Code
|
HCPCS 84106
|
| Hospital Charge Code |
39990017A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$15.83
|
| Rate for Payer: Aetna Medicare Advantage |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.11
|
| Rate for Payer: Cigna Commercial |
$14.70
|
| Rate for Payer: Cigna Medicare Advantage |
$5.82
|
| Rate for Payer: Clover Medicare Advantage |
$5.53
|
| Rate for Payer: EmblemHealth Commercial |
$17.46
|
| Rate for Payer: Humana Medicare Advantage |
$5.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.64
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.83
|
|
|
PORPHOBILINOGEN,URINE II
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
39990017B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.70
|
|
|
PORPHOBILINOGEN,URINE II
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
39990017B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$22.96
|
| Rate for Payer: Aetna Medicare Advantage |
$27.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.62
|
| Rate for Payer: Cigna Commercial |
$29.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.44
|
| Rate for Payer: Clover Medicare Advantage |
$8.02
|
| Rate for Payer: EmblemHealth Commercial |
$25.32
|
| Rate for Payer: Humana Medicare Advantage |
$8.69
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.08
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.65
|
|
|
PORPHOBILINOGEN URINE QUAL
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 84106
|
| Hospital Charge Code |
38477028
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
|
|
PORPHOBILINOGEN URINE QUAL
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 84106
|
| Hospital Charge Code |
38477028
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$15.83
|
| Rate for Payer: Aetna Medicare Advantage |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.11
|
| Rate for Payer: Cigna Commercial |
$15.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.82
|
| Rate for Payer: Clover Medicare Advantage |
$5.53
|
| Rate for Payer: EmblemHealth Commercial |
$17.46
|
| Rate for Payer: Humana Medicare Advantage |
$5.99
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.80
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.85
|
|
|
PORPHYRINS 24 HR URINE A
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84120
|
| Hospital Charge Code |
397080010A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$40.01
|
| Rate for Payer: Aetna Medicare Advantage |
$47.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.36
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.71
|
| Rate for Payer: Clover Medicare Advantage |
$13.97
|
| Rate for Payer: EmblemHealth Commercial |
$44.13
|
| Rate for Payer: Humana Medicare Advantage |
$15.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.71
|
| 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 |
$11.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|