|
MRI CERVICAL SP W/WO CONT
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
94061083
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI CERVICAL SP W/WO CONT
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
94061083
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$325.35 |
| Max. Negotiated Rate |
$6,162.00 |
| 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 |
$927.92
|
| 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 |
$414.47
|
| 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 |
$4,050.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$878.00
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$325.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MRI CHEST
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
94061047
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$6,162.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,023.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,023.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$580.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,023.24
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,050.00
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$325.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MRI CHEST
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
94061047
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI CHEST LYMPHADEN H/M W CNTR
|
Facility
|
OP
|
$2,210.50
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
2400595
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$53.27 |
| Max. Negotiated Rate |
$6,162.00 |
| Rate for Payer: Aetna Commercial |
$2,533.19
|
| Rate for Payer: Aetna Medicare Advantage |
$3,017.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,361.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,361.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$931.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$576.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,361.79
|
| Rate for Payer: Cigna Commercial |
$1,866.82
|
| Rate for Payer: Cigna Medicare Advantage |
$931.32
|
| Rate for Payer: Clover Medicare Advantage |
$884.75
|
| Rate for Payer: EmblemHealth Commercial |
$2,793.96
|
| Rate for Payer: Humana Medicare Advantage |
$959.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$931.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$663.15
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$331.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$53.27
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$931.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$931.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$58.58
|
|
|
MRI CHEST LYMPHADEN H/M W CNTR
|
Facility
|
IP
|
$2,210.50
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
2400595
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$331.57 |
| Max. Negotiated Rate |
$331.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$331.57
|
|
|
MRI CHEST LYMPHADEN H/M W/O CO
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
2400109
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI CHEST LYMPHADEN H/M W/O CO
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
2400109
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$6,162.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,023.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,023.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$580.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,023.24
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,050.00
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$325.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MRI CHEST LYMPHADEN H/M W/ W/O
|
Facility
|
IP
|
$3,016.40
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
2400596
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$452.46 |
| Max. Negotiated Rate |
$452.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$452.46
|
|
|
MRI CHEST LYMPHADEN H/M W/ W/O
|
Facility
|
OP
|
$3,016.40
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
2400596
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$72.70 |
| Max. Negotiated Rate |
$6,162.00 |
| 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 |
$937.74
|
| 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 |
$414.47
|
| 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 |
$904.92
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$452.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$72.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.93
|
|
|
MRI CHEST W/ CONTRAST
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
2400432
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI CHEST W/ CONTRAST
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
2400432
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.35 |
| Max. Negotiated Rate |
$6,162.00 |
| Rate for Payer: Aetna Commercial |
$2,533.19
|
| Rate for Payer: Aetna Medicare Advantage |
$3,017.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,361.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,361.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$931.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$576.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,361.79
|
| Rate for Payer: Cigna Commercial |
$1,866.82
|
| Rate for Payer: Cigna Medicare Advantage |
$931.32
|
| Rate for Payer: Clover Medicare Advantage |
$884.75
|
| Rate for Payer: EmblemHealth Commercial |
$2,793.96
|
| Rate for Payer: Humana Medicare Advantage |
$959.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$931.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,050.00
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$325.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$931.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$931.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MRI CHEST W/O CONTRAST
|
Facility
|
IP
|
$2,620.85
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
2400550
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$393.13 |
| Max. Negotiated Rate |
$393.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.13
|
|
|
MRI CHEST W/O CONTRAST
|
Facility
|
OP
|
$2,620.85
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
2400550
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$63.16 |
| Max. Negotiated Rate |
$6,162.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,023.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,023.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$580.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,023.24
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.25
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$69.45
|
|
|
MRI CHEST W/ OR W/O CONT
|
Facility
|
OP
|
$2,620.85
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
2400117
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$63.16 |
| Max. Negotiated Rate |
$6,162.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,023.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,023.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$580.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,023.24
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.25
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$69.45
|
|
|
MRI CHEST W/ OR W/O CONT
|
Facility
|
IP
|
$2,620.85
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
2400117
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$393.13 |
| Max. Negotiated Rate |
$393.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.13
|
|
|
MRI CHEST W/ & W/O CONTRAST
|
Facility
|
IP
|
$3,016.40
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
2400549
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$452.46 |
| Max. Negotiated Rate |
$452.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$452.46
|
|
|
MRI CHEST W/ & W/O CONTRAST
|
Facility
|
OP
|
$3,016.40
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
2400549
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$72.70 |
| Max. Negotiated Rate |
$6,162.00 |
| 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 |
$937.74
|
| 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 |
$414.47
|
| 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 |
$904.92
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$452.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$72.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.93
|
|
|
MRI CHEST W/WO CONTRAST
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
94061049
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.35 |
| Max. Negotiated Rate |
$6,162.00 |
| 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 |
$937.74
|
| 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 |
$414.47
|
| 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 |
$4,050.00
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$325.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MRI CHEST W/WO CONTRAST
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
94061049
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI DORSAL SPINE
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72146
|
| Hospital Charge Code |
94061075
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI DORSAL SPINE
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72146
|
| Hospital Charge Code |
94061075
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$6,162.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,023.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,023.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$638.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,023.24
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,050.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$567.00
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$325.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MRI DORSAL SPINE W/WO CON
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
94061085
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$325.35 |
| Max. Negotiated Rate |
$6,162.00 |
| 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 |
$927.92
|
| 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 |
$414.47
|
| 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 |
$4,050.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$820.00
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$325.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MRI DORSAL SPINE W/WO CON
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
94061085
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI DORSAL SP W/GAD INJ
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72147
|
| Hospital Charge Code |
94061077
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
