Medicaid Provider SpendingClaims paid 2018–2024 · HHS public file
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Hospital

Prime Healthcare Services - Saint Clare's LLC

Prime Healthcare Services - Saint Clare's LLC was paid $90.22M by Medicaid between Jan 2018 and Dec 2024, across 282 billing codes. Its largest line is A0427, emergency ambulance ride, advanced life support — 12% of everything it billed.

33Billing provider infoPRIME HEALTHCARE SERVICES - SAINT CLARE'S LLC
DENVILLE, NJ 07834
33aNPI1598144362assigned 05/26/2015
28Total paid$90.22M
24GClaims991,910
24DCodes billed282
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers

Next to other General Acute Care Hospital providers in New Jersey

Rank by total paid#20 of 93
Median peer was paid$30.60M
This provider vs. median2.9×

Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.

Box 24A · Dates of service

Paid by month

$0$500K$1.0M$1.5M2018201920202021202220232024
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
YearClaimsPaid
2018158,621$13.71M
2019141,298$12.64M
2020122,266$11.74M
2021150,648$14.76M
2022168,493$14.99M
2023153,584$13.08M
2024incomplete97,000$9.30M
Box 24 · Service lines

What it billed for

CodeServiceShareClaimsBene. recordsPaid
A0427 Emergency ambulance ride, advanced life supportAmbulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) 12% 12,188 11,208 $10.77M
99284 Emergency room visit (serious)Emergency department visit for the evaluation and management, high severity 9.8% 25,380 22,922 $8.82M
A0429 Emergency ambulance ride, basic life supportAmbulance service, basic life support, emergency transport (bls-emergency) 8.5% 35,943 29,947 $7.66M
99283 Emergency room visit (moderate)Emergency department visit for the evaluation and management, moderate severity 7.3% 23,487 21,718 $6.61M
99285 Emergency room visit (most serious)Emergency department visit for the evaluation and management, high severity with immediate threat to life 7.2% 16,104 14,589 $6.47M
H0035 Mental health partial hospitalization, treatment, less than 24 hours 6.5% 33,399 3,832 $5.85M
90834 Psychotherapy session, about 45 minutesPsychotherapy, 45 minutes with patient 4.6% 37,370 24,107 $4.18M
A0428 Ambulance service, basic life support, non-emergency transport, (bls) 4.3% 14,133 11,695 $3.92M
S9480 Intensive outpatient psychiatric services, per diem 3.9% 4,433 3,991 $3.47M
90791 Psychiatric diagnostic evaluationPsychiatric diagnostic evaluation 2.8% 19,150 16,453 $2.50M
G0378 Hospital observation service, per hour 2.5% 7,217 5,182 $2.24M
A0425 Ground mileage, per statute mile 1.9% 60,671 47,513 $1.71M
270 more codes
99214 Doctor's office visit, returning patient (more involved) 1.7% 21,379 $1.54M
OP272 1.4% 21,590 $1.22M
90837 Psychotherapy session, about an hour 1.3% 10,664 $1.16M
96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance 1.2% 9,469 $1.11M
99213 Doctor's office visit, returning patient (routine) 1.2% 14,224 $1.07M
T2034 Crisis intervention, waiver; per diem 1.1% 1,282 $1.02M
99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes 1.0% 1,974 $936K
90792 Psychiatric diagnostic evaluation with medical services <1% 6,410 $821K
90832 Psychotherapy session, about 30 minutes <1% 12,081 $775K
74177 Computed tomography, abdomen and pelvis; with contrast material <1% 2,762 $614K
A0998 Ambulance response and treatment, no transport <1% 403 $611K
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular <1% 11,785 $516K
80307 Drug test(s), presumptive, any number of drug classes; immunoassay <1% 12,172 $513K
93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report <1% 12,761 $455K
A0434 Specialty care transport (sct) <1% 466 $446K
90853 Group psychotherapy (other than of a multiple-family group) <1% 12,595 $445K
G0463 Hospital outpatient clinic visit for assessment and management of a patient <1% 14,160 $442K
71045 Radiologic examination, chest; single view <1% 9,507 $399K
96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour <1% 3,024 $397K
U0003 Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r <1% 6,236 $384K
G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed <1% 7,535 $377K
96361 Intravenous infusion, hydration; each additional hour <1% 6,984 $363K
OP710 <1% 2,037 $361K
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour <1% 2,825 $340K
74176 Computed tomography, abdomen and pelvis; without contrast material <1% 2,402 $339K
77067 Screening mammography, bilateral, including computer-aided detection <1% 3,178 $328K
99281 Emergency department visit for the evaluation and management, self-limited or minor <1% 2,416 $325K
70450 Computed tomography, head or brain; without contrast material <1% 4,634 $302K
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction <1% 2,459 $297K
87426 Infectious agent antigen detection, SARS-CoV-2 (COVID-19) <1% 10,785 $279K
97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion <1% 10,380 $273K
OP370 <1% 2,217 $249K
OP250 <1% 46,166 $230K
76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up <1% 2,435 $224K
Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml <1% 4,780 $223K
99282 Emergency department visit for the evaluation and management, low to moderate severity <1% 1,204 $215K
85025 Blood count; complete (CBC), automated, and automated differential WBC count <1% 26,822 $215K
93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete <1% 685 $209K
A0433 Advanced life support, level 2 (als 2) <1% 137 $193K
96375 Therapeutic injection; each additional sequential IV push <1% 5,327 $187K
76700 Ultrasound, abdominal, real time with image documentation; complete <1% 2,221 $171K
99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity <1% 2,160 $166K
71046 Radiologic examination, chest; 2 views <1% 4,820 $165K
97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination <1% 6,649 $157K
11042 Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm <1% 850 $144K
76641 <1% 1,510 $131K
80320 <1% 4,262 $131K
C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source <1% 8,121 $128K
76819 Fetal biophysical profile; without non-stress testing <1% 1,318 $128K
OP271 <1% 11,067 $120K
80048 Basic metabolic panel (calcium, ionized) <1% 14,909 $116K
76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed <1% 548 $106K
80053 Comprehensive metabolic panel <1% 12,317 $105K
36415 Collection of venous blood by venipuncture <1% 31,464 $105K
G0379 Direct admission of patient for hospital observation care <1% 199 $91K
U0005 Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 <1% 4,670 $88K
90715 <1% 1,587 $88K
OP259 <1% 9,401 $88K
87804 Infectious agent antigen detection by immunoassay; Influenza, each type <1% 6,202 $85K
76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete <1% 1,132 $82K
80306 <1% 3,670 $80K
73130 <1% 1,776 $77K
73630 <1% 1,967 $76K
99241 <1% 3,246 $75K
90833 Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) <1% 1,434 $72K
80305 <1% 3,422 $71K
J3490 Unclassified drugs <1% 6,619 $69K
93975 <1% 545 $63K
94664 <1% 754 $63K
74018 <1% 1,389 $60K
73610 <1% 1,521 $60K
78452 Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress <1% 159 $58K
93017 <1% 323 $55K
84484 <1% 7,454 $55K
93976 <1% 501 $52K
OP270 <1% 5,549 $51K
73030 <1% 1,319 $51K
86900 <1% 1,888 $51K
72125 Computed tomography, cervical spine; without contrast material <1% 855 $50K
84443 Thyroid stimulating hormone (TSH) <1% 3,030 $49K
77063 Screening digital breast tomosynthesis, bilateral <1% 1,978 $47K
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine <1% 1,364 $46K
81025 <1% 13,447 $45K
73562 <1% 1,202 $45K
87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe <1% 1,347 $44K
59025 Fetal non-stress test <1% 336 $44K
76830 Ultrasound, transvaginal <1% 528 $43K
U0002 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc <1% 1,128 $42K
97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) <1% 1,018 $41K
72100 <1% 644 $39K
87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe <1% 1,334 $38K
87633 Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets <1% 117 $37K
J7030 Infusion, normal saline solution , 1000 cc <1% 9,640 $37K
83690 <1% 7,712 $37K
87070 <1% 4,733 $34K
76801 <1% 418 $32K
96376 <1% 700 $32K
87086 Culture, bacterial; quantitative colony count, urine <1% 6,390 $31K
82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed <1% 1,027 $29K
82962 <1% 6,234 $29K
97161 <1% 448 $28K
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A <1% 2,564 $28K
82550 <1% 4,952 $28K
93970 <1% 232 $27K
83880 <1% 1,215 $27K
Q0162 Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen <1% 1,888 $27K
96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour <1% 372 $26K
71275 Computed tomographic angiography, chest, with contrast material <1% 187 $26K
80076 <1% 4,455 $26K
90847 Family psychotherapy with the patient present, 50 minutes <1% 461 $26K
J1885 Injection, ketorolac tromethamine, per 15 mg <1% 6,182 $26K
80061 Lipid panel <1% 2,004 $25K
99215 Doctor's office visit, returning patient (complex) <1% 329 $24K
A9270 Non-covered item or service <1% 637 $24K
82075 <1% 3,143 $24K
99242 <1% 209 $23K
73110 <1% 570 $23K
88305 Level IV - Surgical pathology, gross and microscopic examination <1% 461 $21K
81001 <1% 10,256 $21K
85730 <1% 5,296 $20K
0202U Oncology (prostate), multianalyte, gene expression profiling <1% 193 $20K
87502 Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets <1% 284 $20K
87661 Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe <1% 909 $20K
85610 <1% 5,706 $19K
86850 <1% 1,707 $19K
87186 <1% 1,257 $18K
J2704 Injection, propofol, 10 mg <1% 2,534 $18K
76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal <1% 215 $18K
87798 Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism <1% 446 $16K
76813 <1% 159 $16K
85027 <1% 3,710 $15K
87088 <1% 3,033 $14K
87275 <1% 1,478 $13K
86901 <1% 1,757 $13K
83735 <1% 2,734 $13K
77080 <1% 251 $13K
97010 <1% 2,303 $13K
81003 <1% 6,868 $13K
87040 <1% 1,432 $13K
29125 <1% 84 $13K
84439 <1% 1,443 $12K
87077 <1% 1,603 $12K
82553 <1% 1,528 $12K
87806 <1% 501 $12K
83605 <1% 1,393 $12K
87081 <1% 1,660 $12K
J2060 Injection, lorazepam, 2 mg <1% 2,342 $11K
J0696 Injection, ceftriaxone sodium, per 250 mg <1% 904 $11K
87420 <1% 1,031 $11K
J2405 Injection, ondansetron hydrochloride, per 1 mg <1% 6,277 $11K
74019 <1% 132 $11K
OP720 <1% 64 $10K
87276 <1% 1,479 $10K
12001 <1% 61 $9K
73502 <1% 276 $9K
84702 <1% 728 $9K
97530 Therapeutic activities, direct patient contact, each 15 minutes <1% 382 $9K
80164 <1% 348 $9K
87389 Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies <1% 332 $8K
OP279 <1% 707 $8K
OP258 <1% 775 $8K
83036 Hemoglobin; glycosylated (A1C) <1% 1,591 $8K
J7120 Ringers lactate infusion, up to 1000 cc <1% 1,648 $7K
72110 <1% 120 $7K
73560 <1% 235 $7K
51798 <1% 146 $7K
77065 Tomosynthesis, mammo <1% 68 $7K
J1170 Injection, hydromorphone, up to 4 mg <1% 1,546 $6K
85379 <1% 1,405 $6K
82150 <1% 1,132 $5K
81220 CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants <1% 12 $5K
J3010 Injection, fentanyl citrate, 0.1 mg <1% 1,741 $4K
82947 <1% 1,175 $4K
76770 <1% 67 $4K
73080 <1% 114 $4K
76536 <1% 53 $4K
J7060 5% dextrose/water (500 ml = 1 unit) <1% 1,929 $4K
J0690 Injection, cefazolin sodium, 500 mg <1% 567 $4K
J7040 Infusion, normal saline solution, sterile (500 ml = 1 unit) <1% 1,125 $3K
85378 <1% 530 $3K
97116 <1% 112 $3K
J1200 Injection, diphenhydramine hcl, up to 50 mg <1% 1,386 $3K
87486 <1% 114 $3K
87581 <1% 113 $3K
80329 <1% 40 $3K
J1100 Injection, dexamethasone sodium phosphate, 1 mg <1% 2,654 $3K
10060 <1% 12 $3K
85007 <1% 1,202 $3K
83655 <1% 279 $3K
84703 <1% 294 $2K
80354 <1% 80 $2K
93880 <1% 41 $2K
87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe <1% 236 $2K
J0131 Injection, acetaminophen, not otherwise specified,10 mg <1% 393 $2K
12011 <1% 12 $2K
M0222 Intravenous injection, bebtelovimab, includes injection and post administration monitoring <1% 19 $2K
97597 <1% 25 $2K
J2250 Injection, midazolam hydrochloride, per 1 mg <1% 882 $2K
87205 <1% 363 $2K
72050 <1% 42 $2K
J2543 Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) <1% 86 $2K
97162 <1% 27 $2K
74021 <1% 26 $2K
76815 Ultrasound, pregnant uterus, real time with image documentation, limited <1% 15 $1K
72040 <1% 42 $1K
80074 <1% 56 $1K
87299 <1% 109 $1K
J2270 Injection, morphine sulfate, up to 10 mg <1% 544 $1K
86592 <1% 441 $1K
J2765 Injection, metoclopramide hcl, up to 10 mg <1% 731 $955.27
J7512 Prednisone, immediate release or delayed release, oral, 1 mg <1% 932 $855.17
87340 <1% 184 $844.45
G0008 Administration of influenza virus vaccine <1% 41 $795.38
29130 <1% 14 $764.53
J1630 Injection, haloperidol, up to 5 mg <1% 509 $760.17
82950 <1% 125 $724.37
J2930 Injection, methylprednisolone sodium succinate, up to 125 mg <1% 153 $681.71
83020 <1% 113 $679.39
93225 <1% 12 $671.73
76818 <1% 12 $647.80
71100 <1% 27 $622.61
82465 <1% 184 $618.84
36600 <1% 13 $600.59
80178 <1% 19 $550.97
76705 Ultrasound, abdominal, real time with image documentation; limited <1% 12 $543.53
86618 <1% 29 $531.74
A4606 Oxygen probe for use with oximeter device, replacement <1% 17 $502.88
88304 <1% 15 $484.38
A9575 Injection, gadoterate meglumine, 0.1 ml <1% 17 $484.04
82248 <1% 95 $444.01
84480 <1% 30 $436.50
93296 <1% 13 $435.03
84100 <1% 152 $427.79
J3411 Injection, thiamine hcl, 100 mg <1% 146 $417.34
J0665 Injection, bupivicaine, not otherwise specified, 0.5 mg <1% 173 $400.19
90686 <1% 14 $383.28
Q0163 Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen <1% 682 $362.57
A9500 Technetium tc-99m sestamibi, diagnostic, per study dose <1% 26 $361.81
83021 <1% 16 $344.00
82247 <1% 119 $337.30
82105 <1% 24 $272.90
86762 <1% 98 $272.42
J2001 Injection, lidocaine hcl for intravenous infusion, 10 mg <1% 549 $263.43
87147 <1% 24 $252.30
36416 <1% 133 $220.80
94760 <1% 27 $159.18
A6449 Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard <1% 90 $137.86
J1650 Injection, enoxaparin sodium, 10 mg <1% 40 $113.86
85652 <1% 79 $100.99
J0780 Injection, prochlorperazine, up to 10 mg <1% 31 $95.85
S0020 Injection, bupivicaine hydrochloride, 30 ml <1% 14 $81.65
J2470 Injection, pantoprazole sodium, 40 mg <1% 19 $76.06
A4930 Gloves, sterile, per pair <1% 22 $76.04
85660 <1% 16 $48.00
A6402 Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing <1% 42 $46.11
82805 <1% 13 $43.38
J1171 Injection, hydromorphone, 0.1 mg <1% 15 $39.27
A4657 Syringe, with or without needle, each <1% 35 $39.14
A4223 Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) <1% 29 $38.35
J7510 Prednisolone oral, per 5 mg <1% 18 $28.59
81002 <1% 41 $23.55
P9603 Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled <1% 66 $23.00
OP255 <1% 13 $21.19
J2003 Injection, lidocaine hydrochloride, 1 mg <1% 41 $16.67
Q0245 Injection, bamlanivimab and etesevimab, 2100 mg <1% 12 $12.41
J1815 Injection, insulin, per 5 units <1% 21 $5.69
Q0222 Injection, bebtelovimab, 175 mg <1% 20 $5.47
84132 <1% 12 $1.00
G8978 Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals 0% 26 $0.00
G8979 Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting 0% 27 $0.00

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.

From NPPES

Who's on the registration

Authorized officialHEATHER, MICHAEL (CHIEF FINANCIAL OFFICER)
Same official

Other billing entities under HEATHER, MICHAEL

Full network →
ProviderLocationPaid
Prime Healthcare Services - Saint Clare's LLCDenville, NJ$4.71M
Prime Healthcare Services - Saint Clare's LLCBoonton Township, NJ$3.75M

Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.