|
MR LWR EXT OTH THN LT RT W/ C
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 73719RT
|
| Hospital Charge Code |
2400276
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.35 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,442.50
|
| Rate for Payer: Cigna Commercial |
$6,750.00
|
| 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: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MR PELVIS W/O C
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
2400233
|
|
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 |
$532.40
|
| 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
|
|
|
MR PELVIS W/O C
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
2400233
|
|
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
|
|
|
MR PELVIS W/WO C
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
2400234
|
|
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
|
|
|
MR PELVIS W/WO C
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
2400234
|
|
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 |
$949.18
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$1,543.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MRSA ICU ADMIT
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
38479065
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$7.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.05
|
|
|
MRSA ICU ADMIT
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
38479065
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$18.03
|
| Rate for Payer: Aetna Medicare Advantage |
$21.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.93
|
| Rate for Payer: Cigna Commercial |
$23.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6.63
|
| Rate for Payer: Clover Medicare Advantage |
$6.30
|
| Rate for Payer: EmblemHealth Commercial |
$19.89
|
| Rate for Payer: Humana Medicare Advantage |
$6.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.25
|
|
|
MRSA ICU DISCHARGE
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
38479068
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$7.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.05
|
|
|
MRSA ICU DISCHARGE
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
38479068
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$18.03
|
| Rate for Payer: Aetna Medicare Advantage |
$21.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.93
|
| Rate for Payer: Cigna Commercial |
$23.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6.63
|
| Rate for Payer: Clover Medicare Advantage |
$6.30
|
| Rate for Payer: EmblemHealth Commercial |
$19.89
|
| Rate for Payer: Humana Medicare Advantage |
$6.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.25
|
|
|
MRSA SCREEN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
38478075
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$18.03
|
| Rate for Payer: Aetna Medicare Advantage |
$21.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.93
|
| Rate for Payer: Cigna Commercial |
$23.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6.63
|
| Rate for Payer: Clover Medicare Advantage |
$6.30
|
| Rate for Payer: EmblemHealth Commercial |
$19.89
|
| Rate for Payer: Humana Medicare Advantage |
$6.83
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.25
|
|
|
MRSA SCREEN
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
38478075
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$7.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.05
|
|
|
MR-STAPH DNA AMP PROBE
|
Facility
|
IP
|
$248.54
|
|
|
Service Code
|
HCPCS 87641
|
| Hospital Charge Code |
39990241
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.28
|
|
|
MR-STAPH DNA AMP PROBE
|
Facility
|
OP
|
$248.54
|
|
|
Service Code
|
HCPCS 87641
|
| Hospital Charge Code |
39990241
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$126.66 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$94.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.66
|
| Rate for Payer: Cigna Commercial |
$124.27
|
| Rate for Payer: Cigna Medicare Advantage |
$35.09
|
| Rate for Payer: Clover Medicare Advantage |
$33.34
|
| Rate for Payer: EmblemHealth Commercial |
$105.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$35.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$74.56
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.59
|
|
|
MR UPP EX ANY JT UPP LT W/ C
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 73222LT
|
| Hospital Charge Code |
2400255
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.35 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,442.50
|
| Rate for Payer: Cigna Commercial |
$6,750.00
|
| 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: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MR UPP EX ANY JT UPP LT W/ C
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 73222LT
|
| Hospital Charge Code |
2400255
|
|
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
|
|
|
MR UPP EX ANY JT UPP LT W/WO C
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 73223LT
|
| Hospital Charge Code |
2400256
|
|
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
|
|
|
MR UPP EX ANY JT UPP LT W/WO C
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 73223LT
|
| Hospital Charge Code |
2400256
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.35 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,442.50
|
| Rate for Payer: Cigna Commercial |
$6,750.00
|
| 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: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MR UPP EX ANY JT UPP RT W/WO C
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 73223RT
|
| Hospital Charge Code |
2400260
|
|
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
|
|
|
MR UPP EX ANY JT UPP RT W/WO C
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 73223RT
|
| Hospital Charge Code |
2400260
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.35 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,442.50
|
| Rate for Payer: Cigna Commercial |
$6,750.00
|
| 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: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MR UPP EX OTH THN JT LT W/ C
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 73219LT
|
| Hospital Charge Code |
2400267
|
|
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
|
|
|
MR UPP EX OTH THN JT LT W/ C
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 73219LT
|
| Hospital Charge Code |
2400267
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.35 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,442.50
|
| Rate for Payer: Cigna Commercial |
$6,750.00
|
| 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: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MR UPP EX OTH THN JT LT W/O C
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 73218LT
|
| Hospital Charge Code |
2400269
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.35 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,442.50
|
| Rate for Payer: Cigna Commercial |
$6,750.00
|
| 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: Wellpoint Medicaid Managed Care |
$357.75
|
|
|
MR UPP EX OTH THN JT LT W/O C
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 73218LT
|
| Hospital Charge Code |
2400269
|
|
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
|
|
|
MR UPP EX OTH THN JT RT W/ C
|
Facility
|
IP
|
$2,210.50
|
|
|
Service Code
|
HCPCS 73219RT
|
| Hospital Charge Code |
2400278
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$331.57 |
| Max. Negotiated Rate |
$331.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$331.57
|
|
|
MR UPP EX OTH THN JT RT W/ C
|
Facility
|
OP
|
$2,210.50
|
|
|
Service Code
|
HCPCS 73219RT
|
| Hospital Charge Code |
2400278
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$53.27 |
| Max. Negotiated Rate |
$6,162.00 |
| Rate for Payer: Aetna Commercial |
$839.99
|
| Rate for Payer: Aetna Medicare Advantage |
$663.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$563.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$563.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$563.68
|
| Rate for Payer: Cigna Commercial |
$1,105.25
|
| 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: Wellpoint Medicaid Managed Care |
$58.58
|
|
