|
CH ESTROGEN TOTAL S
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS 82672
|
| Hospital Charge Code |
397072063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$20.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.10
|
|
|
CH ESTROGEN TOTAL S
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 82672
|
| Hospital Charge Code |
397072063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$59.02
|
| Rate for Payer: Aetna Medicare Advantage |
$70.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.33
|
| Rate for Payer: Cigna Commercial |
$67.00
|
| Rate for Payer: Cigna Medicare Advantage |
$21.70
|
| Rate for Payer: Clover Medicare Advantage |
$20.61
|
| Rate for Payer: EmblemHealth Commercial |
$65.10
|
| Rate for Payer: Humana Medicare Advantage |
$22.35
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.55
|
|
|
CH ESTRONE E1
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 82679
|
| Hospital Charge Code |
397071044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Aetna Medicare Advantage |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$90.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$90.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$90.06
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: Cigna Medicare Advantage |
$24.95
|
| Rate for Payer: Clover Medicare Advantage |
$23.70
|
| Rate for Payer: EmblemHealth Commercial |
$74.85
|
| Rate for Payer: Humana Medicare Advantage |
$25.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.96
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.94
|
|
|
CH ESTRONE E1
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 82679
|
| Hospital Charge Code |
397071044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
CHEST TUBE INSERTION
|
Facility
|
IP
|
$2,289.68
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
83091001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$343.45 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$343.45
|
|
|
CHEST TUBE INSERTION
|
Facility
|
OP
|
$2,289.68
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
83080001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$15,354.26 |
| Rate for Payer: Aetna Commercial |
$11,569.82
|
| Rate for Payer: Aetna Medicare Advantage |
$13,781.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,354.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,354.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,253.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15,354.26
|
| Rate for Payer: Cigna Commercial |
$8,526.35
|
| Rate for Payer: Cigna Medicare Advantage |
$4,253.61
|
| Rate for Payer: Clover Medicare Advantage |
$4,040.93
|
| Rate for Payer: EmblemHealth Commercial |
$12,760.83
|
| Rate for Payer: Humana Medicare Advantage |
$4,381.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,253.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$686.90
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$343.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.68
|
|
|
CHEST TUBE INSERTION
|
Facility
|
OP
|
$2,289.68
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
83092001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$15,354.26 |
| Rate for Payer: Aetna Commercial |
$11,569.82
|
| Rate for Payer: Aetna Medicare Advantage |
$13,781.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,354.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,354.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,253.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15,354.26
|
| Rate for Payer: Cigna Commercial |
$8,526.35
|
| Rate for Payer: Cigna Medicare Advantage |
$4,253.61
|
| Rate for Payer: Clover Medicare Advantage |
$4,040.93
|
| Rate for Payer: EmblemHealth Commercial |
$12,760.83
|
| Rate for Payer: Humana Medicare Advantage |
$4,381.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,253.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$686.90
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$343.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.68
|
|
|
CHEST TUBE INSERTION
|
Facility
|
IP
|
$2,289.68
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
83092001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$343.45 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$343.45
|
|
|
CHEST TUBE INSERTION
|
Facility
|
IP
|
$2,289.68
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
83080001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$343.45 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$343.45
|
|
|
CHEST TUBE INSERTION
|
Facility
|
OP
|
$2,289.68
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
83091001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$15,354.26 |
| Rate for Payer: Aetna Commercial |
$11,569.82
|
| Rate for Payer: Aetna Medicare Advantage |
$13,781.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,354.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,354.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,253.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15,354.26
|
| Rate for Payer: Cigna Commercial |
$8,526.35
|
| Rate for Payer: Cigna Medicare Advantage |
$4,253.61
|
| Rate for Payer: Clover Medicare Advantage |
$4,040.93
|
| Rate for Payer: EmblemHealth Commercial |
$12,760.83
|
| Rate for Payer: Humana Medicare Advantage |
$4,381.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,253.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$686.90
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$343.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,253.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.68
|
|
|
CHEST TWO VIEWS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
94061039
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$281.22
|
| Rate for Payer: Aetna Medicare Advantage |
$334.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$373.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$373.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$103.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$373.21
|
| Rate for Payer: Cigna Commercial |
$207.24
|
| Rate for Payer: Cigna Medicare Advantage |
$72.37
|
| Rate for Payer: Clover Medicare Advantage |
$98.22
|
| Rate for Payer: EmblemHealth Commercial |
$310.17
|
| Rate for Payer: Humana Medicare Advantage |
$106.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$103.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,530.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
CHEST TWO VIEWS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
94061039
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
CHEST TWO VIEWS
|
Facility
|
IP
|
$6,439.57
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
2000545
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$965.94 |
| Max. Negotiated Rate |
$965.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$965.94
|
|
|
CHEST TWO VIEWS
|
Facility
|
OP
|
$6,439.57
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
2000545
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$281.22
|
| Rate for Payer: Aetna Medicare Advantage |
$334.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$373.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$373.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$103.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$373.21
|
| Rate for Payer: Cigna Commercial |
$207.24
|
| Rate for Payer: Cigna Medicare Advantage |
$72.37
|
| Rate for Payer: Clover Medicare Advantage |
$98.22
|
| Rate for Payer: EmblemHealth Commercial |
$310.17
|
| Rate for Payer: Humana Medicare Advantage |
$106.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$103.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,931.87
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$965.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$155.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$170.65
|
|
|
CHEST VALVE HEIMLICH
|
Facility
|
OP
|
$70.88
|
|
| Hospital Charge Code |
270649366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$35.44 |
| Rate for Payer: Aetna Commercial |
$26.93
|
| Rate for Payer: Aetna Medicare Advantage |
$21.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.07
|
| Rate for Payer: Cigna Commercial |
$35.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.26
|
| Rate for Payer: Oxford Commercial |
$14.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.18
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.88
|
|
|
CHEST VALVE HEIMLICH
|
Facility
|
IP
|
$70.88
|
|
| Hospital Charge Code |
270649366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$10.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.63
|
|
|
CHEST W/ CONTRAST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
2200087
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$145.87 |
| Max. Negotiated Rate |
$3,354.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$330.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$752.19
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,850.00
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,354.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$228.95
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$251.75
|
|
|
CHEST W/ CONTRAST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
2200087
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CHEST W/O CONTRAST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
2200103
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$3,354.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$86.94
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,850.00
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,354.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$228.95
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$251.75
|
|
|
CHEST W/O CONTRAST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
2200103
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CHEST W/O & HIGH RES CHEST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
2200104
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CHEST W/O & HIGH RES CHEST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
2200104
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$3,354.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$86.94
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,850.00
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,354.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$228.95
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$251.75
|
|
|
CHEST W/WO CONTRAST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
2200095
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CHEST W/WO CONTRAST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
2200095
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$145.87 |
| Max. Negotiated Rate |
$3,354.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$338.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$752.19
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,850.00
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,354.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$228.95
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$251.75
|
|
|
CH ETHANOL, URINE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 80300
|
| Hospital Charge Code |
397073221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Medicare Advantage |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.90
|
| Rate for Payer: Cigna Commercial |
$90.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.77
|
|
