|
IR-BX BRST PRCT W/DEVC-RT
|
Facility
|
IP
|
$1,746.00
|
|
| Hospital Charge Code |
2690905
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$261.90 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$261.90
|
|
|
IR-BX BRST PRCT W/DEVC-RT
|
Facility
|
OP
|
$1,746.00
|
|
| Hospital Charge Code |
2690905
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$663.48
|
| Rate for Payer: Aetna Medicare Advantage |
$523.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$445.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$445.23
|
| 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 |
$445.23
|
| Rate for Payer: Cigna Commercial |
$873.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$523.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$261.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.27
|
|
|
IR BX LYMPH NODE BI
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 3850550
|
| Hospital Charge Code |
23001107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
IR BX LYMPH NODE BI
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS 3850550
|
| Hospital Charge Code |
23001107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.95 |
| Max. Negotiated Rate |
$4,750.00 |
| Rate for Payer: Aetna Commercial |
$3,610.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,422.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,422.50
|
| 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 |
$2,422.50
|
| Rate for Payer: Cigna Commercial |
$4,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$228.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$251.75
|
|
|
IR BX LYMPH NODE BI
|
Facility
|
IP
|
$9,303.00
|
|
|
Service Code
|
HCPCS 3850550
|
| Hospital Charge Code |
2250432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,395.45 |
| Max. Negotiated Rate |
$1,395.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,395.45
|
|
|
IR BX LYMPH NODE BI
|
Facility
|
OP
|
$9,303.00
|
|
|
Service Code
|
HCPCS 3850550
|
| Hospital Charge Code |
2250432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$224.20 |
| Max. Negotiated Rate |
$4,651.50 |
| Rate for Payer: Aetna Commercial |
$3,535.14
|
| Rate for Payer: Aetna Medicare Advantage |
$2,790.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,372.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,372.26
|
| 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 |
$2,372.26
|
| Rate for Payer: Cigna Commercial |
$4,651.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,790.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,395.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$224.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$246.53
|
|
|
IR BX LYMPH NODE LT
|
Facility
|
IP
|
$6,202.00
|
|
|
Service Code
|
HCPCS 38505LT
|
| Hospital Charge Code |
2250431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$930.30 |
| Max. Negotiated Rate |
$930.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.30
|
|
|
IR BX LYMPH NODE LT
|
Facility
|
OP
|
$6,202.00
|
|
|
Service Code
|
HCPCS 38505LT
|
| Hospital Charge Code |
2250431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.47 |
| Max. Negotiated Rate |
$3,101.00 |
| Rate for Payer: Aetna Commercial |
$2,356.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,860.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,581.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,581.51
|
| 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 |
$1,581.51
|
| Rate for Payer: Cigna Commercial |
$3,101.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,860.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$149.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$164.35
|
|
|
IR BX LYMPH NODE LT
|
Facility
|
OP
|
$6,202.00
|
|
|
Service Code
|
HCPCS 38505LT
|
| Hospital Charge Code |
23001106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.47 |
| Max. Negotiated Rate |
$3,101.00 |
| Rate for Payer: Aetna Commercial |
$2,356.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,860.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,581.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,581.51
|
| 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 |
$1,581.51
|
| Rate for Payer: Cigna Commercial |
$3,101.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,860.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$149.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$164.35
|
|
|
IR BX LYMPH NODE LT
|
Facility
|
IP
|
$6,202.00
|
|
|
Service Code
|
HCPCS 38505LT
|
| Hospital Charge Code |
23001106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$930.30 |
| Max. Negotiated Rate |
$930.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.30
|
|
|
IR BX LYMPH NODE RT
|
Facility
|
OP
|
$6,202.00
|
|
|
Service Code
|
HCPCS 38505RT
|
| Hospital Charge Code |
2250430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.47 |
| Max. Negotiated Rate |
$3,101.00 |
| Rate for Payer: Aetna Commercial |
$2,356.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,860.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,581.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,581.51
|
| 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 |
$1,581.51
|
| Rate for Payer: Cigna Commercial |
$3,101.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,860.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$149.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$164.35
|
|
|
IR BX LYMPH NODE RT
|
Facility
|
OP
|
$6,202.00
|
|
|
Service Code
|
HCPCS 38505RT
|
| Hospital Charge Code |
23001105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.47 |
| Max. Negotiated Rate |
$3,101.00 |
| Rate for Payer: Aetna Commercial |
$2,356.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,860.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,581.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,581.51
|
| 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 |
$1,581.51
|
| Rate for Payer: Cigna Commercial |
$3,101.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,860.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$149.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$164.35
|
|
|
IR BX LYMPH NODE RT
|
Facility
|
IP
|
$6,202.00
|
|
|
Service Code
|
HCPCS 38505RT
|
| Hospital Charge Code |
23001105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$930.30 |
| Max. Negotiated Rate |
$930.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.30
|
|
|
IR BX LYMPH NODE RT
|
Facility
|
IP
|
$6,202.00
|
|
|
Service Code
|
HCPCS 38505RT
|
| Hospital Charge Code |
2250430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$930.30 |
| Max. Negotiated Rate |
$930.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.30
|
|
|
IR BX PROCEDURE TRAY
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
4800960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$5.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.55
|
|
|
IR BX PROCEDURE TRAY
|
Facility
|
OP
|
$37.00
|
|
| Hospital Charge Code |
4800960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Aetna Commercial |
$14.06
|
| Rate for Payer: Aetna Medicare Advantage |
$11.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.44
|
| Rate for Payer: Cigna Commercial |
$18.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.10
|
| Rate for Payer: Oxford Commercial |
$7.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.98
|
|
|
IR BX PROSTATE,NEEDLE OR PUNCH
|
Facility
|
IP
|
$7,457.80
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
7411634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,118.67 |
| Max. Negotiated Rate |
$1,118.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,118.67
|
|
|
IR BX PROSTATE,NEEDLE OR PUNCH
|
Facility
|
OP
|
$7,457.80
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
7411634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.73 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Aetna Commercial |
$2,833.96
|
| Rate for Payer: Aetna Medicare Advantage |
$2,237.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,901.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,901.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,901.74
|
| Rate for Payer: Cigna Commercial |
$3,728.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,237.34
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,118.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$179.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$197.63
|
|
|
IR BX PROSTATE,NEEDLE OR PUNCH
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 55705
|
| Hospital Charge Code |
321055700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.53 |
| Max. Negotiated Rate |
$15,116.59 |
| Rate for Payer: Aetna Commercial |
$11,390.73
|
| Rate for Payer: Aetna Medicare Advantage |
$13,568.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,116.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,116.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4,187.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15,116.59
|
| Rate for Payer: Cigna Commercial |
$8,394.37
|
| Rate for Payer: Cigna Medicare Advantage |
$4,187.77
|
| Rate for Payer: Clover Medicare Advantage |
$3,978.38
|
| Rate for Payer: EmblemHealth Commercial |
$12,563.31
|
| Rate for Payer: Humana Medicare Advantage |
$4,313.40
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4,187.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,056.34
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.53
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4,187.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,187.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.98
|
|
|
IR BX PROSTATE,NEEDLE OR PUNCH
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 55705
|
| Hospital Charge Code |
321055700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR BX PROSTATE,NEEDLE OR PUNCH
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
2670130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR BX PROSTATE,NEEDLE OR PUNCH
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
2670130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.53 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,056.34
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.98
|
|
|
IR-BX SOFT TISSUE-SUPR-BI
|
Facility
|
OP
|
$1,916.00
|
|
|
Service Code
|
HCPCS 2704050
|
| Hospital Charge Code |
2690340
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$46.18 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$728.08
|
| Rate for Payer: Aetna Medicare Advantage |
$574.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$488.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$488.58
|
| 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 |
$488.58
|
| Rate for Payer: Cigna Commercial |
$958.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$574.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$287.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.77
|
|
|
IR-BX SOFT TISSUE-SUPR-BI
|
Facility
|
IP
|
$1,916.00
|
|
|
Service Code
|
HCPCS 2704050
|
| Hospital Charge Code |
2690340
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$287.40 |
| Max. Negotiated Rate |
$287.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$287.40
|
|
|
IR-BX SOFT TISSUE-SUPR-BI
|
Facility
|
OP
|
$1,916.00
|
|
|
Service Code
|
HCPCS 2704050
|
| Hospital Charge Code |
7411776
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$46.18 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$728.08
|
| Rate for Payer: Aetna Medicare Advantage |
$574.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$488.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$488.58
|
| 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 |
$488.58
|
| Rate for Payer: Cigna Commercial |
$958.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$574.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$287.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.77
|
|
