|
CT LUMBAR SPINE W/ C
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
2200112
|
|
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
|
|
|
CT LUMBAR SPINE W/ C
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
2200112
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$228.95 |
| Max. Negotiated Rate |
$3,354.00 |
| Rate for Payer: Aetna Commercial |
$1,127.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,496.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,496.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$414.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$329.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,496.11
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| Rate for Payer: Cigna Medicare Advantage |
$290.13
|
| Rate for Payer: Clover Medicare Advantage |
$393.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,243.41
|
| Rate for Payer: Humana Medicare Advantage |
$426.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$414.47
|
| 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 |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,543.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$251.75
|
|
|
CT LUMBAR SPINE WO C
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
2200111
|
|
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
|
|
|
CT LUMBAR SPINE WO C
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
2200111
|
|
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
|
|
|
CT LUMBAR SPINE W/O & W/ C
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
2200113
|
|
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
|
|
|
CT LUMBAR SPINE W/O & W/ C
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
2200113
|
|
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: Wellcare New Jersey Medicaid/Family Care |
$958.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$251.75
|
|
|
CT Mandible w/o Contrast
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
2200277
|
|
Hospital Revenue Code
|
351
|
| 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 |
$266.20
|
| 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
|
|
|
CT Mandible w/o Contrast
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
2200277
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CT MANDIBLE WO & W CONT
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
2200276
|
|
Hospital Revenue Code
|
351
|
| 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
|
|
|
CT MANDIBLE WO & W CONT
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
2200276
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CT MANDIBLE W/O + W CONTRAST
|
Facility
|
OP
|
$1,217.65
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
2200278
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$29.35 |
| 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 |
$242.00
|
| 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 |
$365.30
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,354.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.27
|
|
|
CT MANDIBLE W/O + W CONTRAST
|
Facility
|
IP
|
$1,217.65
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
2200278
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$182.65 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.65
|
|
|
CT MASTOID W CONTRAST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
2250421
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CT MASTOID W CONTRAST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
2250421
|
|
Hospital Revenue Code
|
351
|
| 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 |
$242.00
|
| 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
|
|
|
CT MASTOID W/O CONTRST
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 70480
|
| Hospital Charge Code |
2250420
|
|
Hospital Revenue Code
|
351
|
| 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 |
$266.20
|
| 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
|
|
|
CT MASTOID W/O CONTRST
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 70480
|
| Hospital Charge Code |
2250420
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CT MAXILLO FACIAL AREA WO C
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
2200327
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
CT MAXILLO FACIAL AREA WO C
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
2200327
|
|
Hospital Revenue Code
|
351
|
| 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 |
$266.20
|
| 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
|
|
|
CT MAXILLO FACIAL AREA W/WO C
|
Facility
|
OP
|
$1,217.65
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
2202328
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$29.35 |
| 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 |
$242.00
|
| 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 |
$365.30
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,354.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.27
|
|
|
CT MAXILLO FACIAL AREA W/WO C
|
Facility
|
IP
|
$1,217.65
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
2202328
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$182.65 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$182.65
|
|
|
CT MAXILLOFACIAL W/ CONTRAST
|
Facility
|
IP
|
$5,288.50
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
2205408
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$793.27 |
| Max. Negotiated Rate |
$793.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$793.27
|
|
|
CT MAXILLOFACIAL W/ CONTRAST
|
Facility
|
OP
|
$5,288.50
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
2205408
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$127.45 |
| 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 |
$242.00
|
| 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 |
$1,586.55
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$793.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,354.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$127.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$140.15
|
|
|
CT MAXILLOFACIAL W/O CONTRAST
|
Facility
|
OP
|
$1,120.75
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
2205409
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$27.01 |
| 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 |
$266.20
|
| 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 |
$336.23
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,354.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.01
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.70
|
|
|
CT MAXILLOFACIAL W/O CONTRAST
|
Facility
|
IP
|
$1,120.75
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
2205409
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$168.11 |
| Max. Negotiated Rate |
$168.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.11
|
|
|
CT MAXILLOFACIAL WO & W
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
2200329
|
|
Hospital Revenue Code
|
351
|
| 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
|
|
