|
ARTERY X-RAYS ABDOMEN
|
Facility
|
IP
|
$25,628.45
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
321075726
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,844.27 |
| Max. Negotiated Rate |
$3,844.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,844.27
|
|
|
ARTERY X-RAYS ABDOMEN
|
Facility
|
OP
|
$25,628.45
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
321075726
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$275.92 |
| Max. Negotiated Rate |
$23,862.86 |
| Rate for Payer: Aetna Commercial |
$17,981.27
|
| Rate for Payer: Aetna Medicare Advantage |
$21,418.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,610.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$275.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,862.86
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: Cigna Medicare Advantage |
$4,627.53
|
| Rate for Payer: Clover Medicare Advantage |
$6,280.22
|
| Rate for Payer: EmblemHealth Commercial |
$19,832.28
|
| Rate for Payer: Humana Medicare Advantage |
$6,809.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,610.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,688.53
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,844.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$617.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$679.15
|
|
|
ARTERY X-RAYS ABDOMEN
|
Facility
|
IP
|
$25,628.45
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
2004877
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,844.27 |
| Max. Negotiated Rate |
$3,844.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,844.27
|
|
|
ARTERY X-RAYS CHEST
|
Facility
|
IP
|
$14,613.44
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
366875756
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,192.02 |
| Max. Negotiated Rate |
$2,192.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,192.02
|
|
|
ARTERY X-RAYS CHEST
|
Facility
|
OP
|
$14,613.44
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
366875756
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$134.65 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$134.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,384.03
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,192.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$352.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$387.26
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
OP
|
$34,050.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
366875741
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$271.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,215.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,107.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$820.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$902.33
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
IP
|
$34,050.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
366875741
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,107.50 |
| Max. Negotiated Rate |
$5,107.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,107.50
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
OP
|
$34,050.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
411075741
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$271.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,215.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,107.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$820.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$902.33
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
IP
|
$34,050.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
411075741
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,107.50 |
| Max. Negotiated Rate |
$5,107.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,107.50
|
|
|
ARTERY X-RAYS LUNGS
|
Facility
|
OP
|
$12,461.85
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
366875743
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$300.33 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$338.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,738.55
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,869.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$300.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$330.24
|
|
|
ARTERY X-RAYS LUNGS
|
Facility
|
OP
|
$12,461.85
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
411075743
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$300.33 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$338.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,738.55
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,869.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$300.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$330.24
|
|
|
ARTERY X-RAYS LUNGS
|
Facility
|
IP
|
$12,461.85
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
411075743
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,869.28 |
| Max. Negotiated Rate |
$1,869.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,869.28
|
|
|
ARTERY X-RAYS LUNGS
|
Facility
|
IP
|
$12,461.85
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
366875743
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,869.28 |
| Max. Negotiated Rate |
$1,869.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,869.28
|
|
|
ARTERY X-RAYS PELVIS
|
Facility
|
IP
|
$25,004.60
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
411075736
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,750.69 |
| Max. Negotiated Rate |
$3,750.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.69
|
|
|
ARTERY X-RAYS PELVIS
|
Facility
|
OP
|
$25,004.60
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
411075736
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$292.72 |
| Max. Negotiated Rate |
$23,862.86 |
| Rate for Payer: Aetna Commercial |
$17,981.27
|
| Rate for Payer: Aetna Medicare Advantage |
$21,418.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,610.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$292.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,862.86
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: Cigna Medicare Advantage |
$4,627.53
|
| Rate for Payer: Clover Medicare Advantage |
$6,280.22
|
| Rate for Payer: EmblemHealth Commercial |
$19,832.28
|
| Rate for Payer: Humana Medicare Advantage |
$6,809.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,610.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,501.38
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$602.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$662.62
|
|
|
ARTERY X-RAYS SPINE
|
Facility
|
OP
|
$25,004.60
|
|
|
Service Code
|
HCPCS 75705
|
| Hospital Charge Code |
366875705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$23,862.86 |
| Rate for Payer: Aetna Commercial |
$17,981.27
|
| Rate for Payer: Aetna Medicare Advantage |
$21,418.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,610.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$344.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,862.86
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: Cigna Medicare Advantage |
$4,627.53
|
| Rate for Payer: Clover Medicare Advantage |
$6,280.22
|
| Rate for Payer: EmblemHealth Commercial |
$19,832.28
|
| Rate for Payer: Humana Medicare Advantage |
$6,809.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,610.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,501.38
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$602.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$662.62
|
|
|
ARTERY X-RAYS SPINE
|
Facility
|
OP
|
$25,004.60
|
|
|
Service Code
|
HCPCS 75705
|
| Hospital Charge Code |
411075705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$23,862.86 |
| Rate for Payer: Aetna Commercial |
$17,981.27
|
| Rate for Payer: Aetna Medicare Advantage |
$21,418.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,610.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$344.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,862.86
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: Cigna Medicare Advantage |
$4,627.53
|
| Rate for Payer: Clover Medicare Advantage |
$6,280.22
|
| Rate for Payer: EmblemHealth Commercial |
$19,832.28
|
| Rate for Payer: Humana Medicare Advantage |
$6,809.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,610.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,501.38
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$602.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$662.62
|
|
|
ARTERY X-RAYS SPINE
|
Facility
|
IP
|
$25,004.60
|
|
|
Service Code
|
HCPCS 75705
|
| Hospital Charge Code |
366875705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,750.69 |
| Max. Negotiated Rate |
$3,750.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.69
|
|
|
ARTERY X-RAYS SPINE
|
Facility
|
IP
|
$25,004.60
|
|
|
Service Code
|
HCPCS 75705
|
| Hospital Charge Code |
411075705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,750.69 |
| Max. Negotiated Rate |
$3,750.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.69
|
|
|
ARTHD CMBN 1INTRSPC LUMBAR
|
Facility
|
OP
|
$108,286.15
|
|
|
Service Code
|
HCPCS 22633
|
| Hospital Charge Code |
1600000292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,626.00 |
| Max. Negotiated Rate |
$116,362.07 |
| Rate for Payer: Aetna Commercial |
$87,681.76
|
| Rate for Payer: Aetna Medicare Advantage |
$104,444.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$116,362.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$116,362.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$32,235.94
|
| 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 |
$116,362.07
|
| Rate for Payer: Cigna Commercial |
$64,616.81
|
| Rate for Payer: Cigna Medicare Advantage |
$32,235.94
|
| Rate for Payer: Clover Medicare Advantage |
$30,624.14
|
| Rate for Payer: EmblemHealth Commercial |
$96,707.82
|
| Rate for Payer: Humana Medicare Advantage |
$33,203.02
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$32,235.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32,485.85
|
| Rate for Payer: Oxford Commercial |
$10,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16,242.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$17,313.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,609.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$32,235.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$32,235.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,869.58
|
|
|
ARTHD CMBN 1INTRSPC LUMBAR
|
Facility
|
IP
|
$108,286.15
|
|
|
Service Code
|
HCPCS 22633
|
| Hospital Charge Code |
1600000292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,242.92 |
| Max. Negotiated Rate |
$16,242.92 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16,242.92
|
|
|
ARTHOFLEX 40x70 mm
|
Facility
|
IP
|
$10,200.00
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
270657242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$2,468.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,040.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,468.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,244.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,530.00
|
|
|
ARTHOFLEX 40x70 mm
|
Facility
|
OP
|
$10,200.00
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
270657242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$2,468.40 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,040.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,468.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,244.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,530.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$270.30
|
|
|
ARTHOFLEX DECELLULARIZED DERMS
|
Facility
|
IP
|
$19,445.00
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
270679770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,916.75 |
| Max. Negotiated Rate |
$4,705.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,889.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,705.69
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,277.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,916.75
|
|
|
ARTHOFLEX DECELLULARIZED DERMS
|
Facility
|
OP
|
$19,445.00
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
270679770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$4,705.69 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,889.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,705.69
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,277.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,916.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$468.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$515.29
|
|
