|
2.3 X 6 BONE SCREW
|
Facility
|
OP
|
$555.00
|
|
| Hospital Charge Code |
270657976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Aetna Commercial |
$210.90
|
| Rate for Payer: Aetna Medicare Advantage |
$166.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$141.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$141.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$141.53
|
| Rate for Payer: Cigna Commercial |
$277.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.31
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$122.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.71
|
|
|
2.3 X 6 BONE SCREW
|
Facility
|
IP
|
$555.00
|
|
| Hospital Charge Code |
270657976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$111.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.31
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$122.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.25
|
|
|
2.3 X 8 BONE SCREW
|
Facility
|
OP
|
$555.00
|
|
| Hospital Charge Code |
270657981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Aetna Commercial |
$210.90
|
| Rate for Payer: Aetna Medicare Advantage |
$166.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$141.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$141.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$141.53
|
| Rate for Payer: Cigna Commercial |
$277.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.31
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$122.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.71
|
|
|
2.3 X 8 BONE SCREW
|
Facility
|
IP
|
$555.00
|
|
| Hospital Charge Code |
270657981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$111.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.31
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$122.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.25
|
|
|
2.3 X 8 LOCK BONE SCREW
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
270657989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$154.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.55
|
|
|
2.3 X 8 LOCK BONE SCREW
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
270657989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$154.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
2.4/2.7 VA FUSION PLATE
|
Facility
|
IP
|
$3,948.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.33 |
| Max. Negotiated Rate |
$955.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$789.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$955.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$868.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$592.33
|
|
|
2.4/2.7 VA FUSION PLATE
|
Facility
|
OP
|
$3,948.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.17 |
| Max. Negotiated Rate |
$1,974.42 |
| Rate for Payer: Aetna Commercial |
$1,500.56
|
| Rate for Payer: Aetna Medicare Advantage |
$1,184.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,006.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,006.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$789.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,006.96
|
| Rate for Payer: Cigna Commercial |
$1,974.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$955.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$868.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$592.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$95.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$104.64
|
|
|
2.4 CANN SCREW 17MM SRT THRD
|
Facility
|
OP
|
$12,525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.85 |
| Max. Negotiated Rate |
$6,262.50 |
| Rate for Payer: Aetna Commercial |
$4,759.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,757.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,193.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,193.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,505.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,193.88
|
| Rate for Payer: Cigna Commercial |
$6,262.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,031.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,755.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,878.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$301.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$331.91
|
|
|
2.4 CANN SCREW 17MM SRT THRD
|
Facility
|
IP
|
$12,525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,878.75 |
| Max. Negotiated Rate |
$3,031.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,505.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,031.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,755.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,878.75
|
|
|
24 HOURS URINE PROTEIN ELECTRO
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
39990066C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$64.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.36
|
| 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 |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.36
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| 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 |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| 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 |
$10.34
|
|
|
24 HOURS URINE PROTEIN ELECTRO
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
39990066A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
24 HOURS URINE PROTEIN ELECTRO
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
39990066C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
24 HOURS URINE PROTEIN ELECTRO
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
39990066B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$195.00 |
| 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 |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.25
|
| 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 |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.25
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| 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 |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| 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 |
$10.34
|
|
|
24 HOURS URINE PROTEIN ELECTRO
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
39990066A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$14.09
|
| Rate for Payer: Aetna Medicare Advantage |
$16.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.70
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.18
|
| Rate for Payer: Clover Medicare Advantage |
$4.92
|
| Rate for Payer: EmblemHealth Commercial |
$15.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
24 HOURS URINE PROTEIN ELECTRO
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
39990066B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
OP
|
$268.50
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3038533H
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Aetna Commercial |
$6.12
|
| Rate for Payer: Aetna Medicare Advantage |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.12
|
| Rate for Payer: Cigna Commercial |
$134.25
|
| Rate for Payer: Cigna Medicare Advantage |
$2.25
|
| Rate for Payer: Clover Medicare Advantage |
$2.14
|
| Rate for Payer: EmblemHealth Commercial |
$6.75
|
| Rate for Payer: Humana Medicare Advantage |
$2.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.55
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.12
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$72.85
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
3038533D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$10.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.93
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$153.65
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3038533I
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.05
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$63.25
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
3038533F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$9.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.49
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$152.65
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
3038533M
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$22.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.90
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$91.25
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
3038533O
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.69
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
3038533J
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
OP
|
$152.65
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
3038533M
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$14.09
|
| Rate for Payer: Aetna Medicare Advantage |
$16.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.70
|
| Rate for Payer: Cigna Commercial |
$76.33
|
| Rate for Payer: Cigna Medicare Advantage |
$5.18
|
| Rate for Payer: Clover Medicare Advantage |
$4.92
|
| Rate for Payer: EmblemHealth Commercial |
$15.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.05
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$61.70
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
3038533C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.26
|
|
