|
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 BY REFRACT ANY S
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 84160
|
| Hospital Charge Code |
38477040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$156.00 |
| 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 |
$20.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.35
|
| 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 |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.35
|
| Rate for Payer: Cigna Commercial |
$18.00
|
| 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 |
$9.36
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| 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 |
$1.02
|
|
|
PROTEIN TOTAL BY REFRACT ANY S
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 84160
|
| Hospital Charge Code |
38477040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.40
|
|
|
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 |
$14.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.51
|
| 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 |
$4.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.51
|
| 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 |
$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 |
$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 |
$11.08
|
|
|
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 |
$3.20 |
| 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 |
$14.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.51
|
| 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 |
$4.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.51
|
| 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 |
$30.16
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| 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 |
$3.29
|
|
|
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 |
$14.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.51
|
| 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 |
$4.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.51
|
| 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 |
$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 |
$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 |
$11.08
|
|
|
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 |
$0.72 |
| Max. Negotiated Rate |
$156.00 |
| 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 |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.31
|
| 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 |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.31
|
| 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 |
$6.55
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| 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 |
$0.72
|
|
|
PROTEIN,TOTAL,SYNOVIAL FL II
|
Facility
|
OP
|
$25.20
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
39990018B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.72 |
| 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 |
$14.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.51
|
| 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 |
$4.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.51
|
| 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 |
$6.55
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| 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 |
$0.72
|
|
|
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, URINE
|
Facility
|
OP
|
$61.70
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
3002243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$156.00 |
| 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 |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.31
|
| 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 |
$4.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.31
|
| 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 |
$16.04
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| 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 |
$1.75
|
|
|
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
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 84181
|
| Hospital Charge Code |
38477143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.00
|
|
|
PROTEIN WESTERN BLOT BODY FLUI
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 84181
|
| Hospital Charge Code |
38477143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$156.00 |
| 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 |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.78
|
| 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 |
$48.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.78
|
| Rate for Payer: Cigna Commercial |
$60.00
|
| 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 |
$31.20
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| 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 |
$3.41
|
|
|
PROTEIN WESTERN BLOT EACH(X6)
|
Facility
|
OP
|
$732.08
|
|
|
Service Code
|
HCPCS 84182
|
| Hospital Charge Code |
40119477A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.79 |
| 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 |
$105.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.96
|
| 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 |
$48.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.96
|
| 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 |
$190.34
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$109.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| 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 |
$20.79
|
|
|
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
|
$125.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
38479109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
PROT ELECTROPHORESIS,UR
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
38479109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$156.00 |
| 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 |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.68
|
| 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 |
$31.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.68
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| 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 |
$32.50
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| 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 |
$3.55
|
|
|
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: Qualcare PPO/HMO/WC |
$10,443.75
|
|
|
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 |
$1,977.35 |
| 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: Qualcare PPO/HMO/WC |
$10,443.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,200.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,977.35
|
|
|
PROTHROMBIN GENE ANALYSIS
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
39900016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$238.29 |
| Rate for Payer: Aetna Commercial |
$178.68
|
| Rate for Payer: Aetna Medicare Advantage |
$212.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$238.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$238.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$65.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$238.29
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$65.69
|
| Rate for Payer: Clover Medicare Advantage |
$62.41
|
| Rate for Payer: EmblemHealth Commercial |
$197.07
|
| Rate for Payer: Humana Medicare Advantage |
$67.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$65.69
|
| 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 |
$52.55
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$65.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
PROTHROMBIN GENE ANALYSIS
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
39900016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
