|
NEEDLELOC MAMMO GUIDE 1ST LES
|
Facility
|
IP
|
$996.25
|
|
|
Service Code
|
HCPCS 19281LT
|
| Hospital Charge Code |
94064009L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.44 |
| Max. Negotiated Rate |
$149.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.44
|
|
|
NEEDLELOC MAMMO GUIDE 1ST LES
|
Facility
|
IP
|
$996.25
|
|
|
Service Code
|
HCPCS 19281RT
|
| Hospital Charge Code |
94064009R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.44 |
| Max. Negotiated Rate |
$149.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.44
|
|
|
NEEDLELOC MAMMO GUIDE 1ST LES
|
Facility
|
OP
|
$996.25
|
|
|
Service Code
|
HCPCS 19281LT
|
| Hospital Charge Code |
94064009L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$378.57
|
| Rate for Payer: Aetna Medicare Advantage |
$298.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$254.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$254.04
|
| 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 |
$254.04
|
| Rate for Payer: Cigna Commercial |
$498.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$298.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.40
|
|
|
NEEDLELOC MAMMO GUIDE ADD LES
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 19282RT
|
| Hospital Charge Code |
94064011R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Aetna Medicare Advantage |
$124.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.68
|
| 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 |
$105.68
|
| Rate for Payer: Cigna Commercial |
$207.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$124.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.98
|
|
|
NEEDLELOC MAMMO GUIDE ADD LES
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 19282RT
|
| Hospital Charge Code |
94064011R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
NEEDLELOC MAMMO GUIDE ADD LES
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 19282LT
|
| Hospital Charge Code |
94064011L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
NEEDLELOC MAMMO GUIDE ADD LES
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 19282LT
|
| Hospital Charge Code |
94064011L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Aetna Medicare Advantage |
$124.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.68
|
| 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 |
$105.68
|
| Rate for Payer: Cigna Commercial |
$207.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$124.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.98
|
|
|
NEEDLE LOC MRI GUIDE 1STLESION
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 19287LT
|
| Hospital Charge Code |
94064021L
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
NEEDLE LOC MRI GUIDE 1STLESION
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 19287LT
|
| Hospital Charge Code |
94064021L
|
|
Hospital Revenue Code
|
610
|
| 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
|
|
|
NEEDLE LOC MRI GUIDE 1STLESION
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 1928750
|
| Hospital Charge Code |
94064021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
NEEDLE LOC MRI GUIDE 1STLESION
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 1928750
|
| Hospital Charge Code |
94064021
|
|
Hospital Revenue Code
|
610
|
| 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
|
|
|
NEEDLE LOC MRI GUIDE 1STLESION
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 19287RT
|
| Hospital Charge Code |
94064021R
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
NEEDLE LOC MRI GUIDE 1STLESION
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 19287RT
|
| Hospital Charge Code |
94064021R
|
|
Hospital Revenue Code
|
610
|
| 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
|
|
|
NEEDLE LOC MRI GUIDE ADDLESION
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 19288
|
| Hospital Charge Code |
94064023
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
NEEDLE LOC MRI GUIDE ADDLESION
|
Facility
|
OP
|
$983.40
|
|
|
Service Code
|
HCPCS 19288
|
| Hospital Charge Code |
94064023L
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$6,162.00 |
| Rate for Payer: Aetna Commercial |
$373.69
|
| Rate for Payer: Aetna Medicare Advantage |
$295.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$250.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$250.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$250.77
|
| Rate for Payer: Cigna Commercial |
$491.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$295.02
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.06
|
|
|
NEEDLE LOC MRI GUIDE ADDLESION
|
Facility
|
IP
|
$983.40
|
|
|
Service Code
|
HCPCS 19288
|
| Hospital Charge Code |
94064023L
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$147.51 |
| Max. Negotiated Rate |
$147.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.51
|
|
|
NEEDLE LOC MRI GUIDE ADDLESION
|
Facility
|
OP
|
$983.40
|
|
|
Service Code
|
HCPCS 19288
|
| Hospital Charge Code |
94064023R
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$6,162.00 |
| Rate for Payer: Aetna Commercial |
$373.69
|
| Rate for Payer: Aetna Medicare Advantage |
$295.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$250.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$250.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$250.77
|
| Rate for Payer: Cigna Commercial |
$491.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$295.02
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.06
|
|
|
NEEDLE LOC MRI GUIDE ADDLESION
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 19288
|
| Hospital Charge Code |
94064023
|
|
Hospital Revenue Code
|
610
|
| 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
|
|
|
NEEDLE LOC MRI GUIDE ADDLESION
|
Facility
|
IP
|
$983.40
|
|
|
Service Code
|
HCPCS 19288
|
| Hospital Charge Code |
94064023R
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$147.51 |
| Max. Negotiated Rate |
$147.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.51
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
IP
|
$1,597.20
|
|
|
Service Code
|
HCPCS 19283LT
|
| Hospital Charge Code |
94064013L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.58 |
| Max. Negotiated Rate |
$239.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$239.58
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
OP
|
$1,597.20
|
|
|
Service Code
|
HCPCS 19283LT
|
| Hospital Charge Code |
94064013L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$606.94
|
| Rate for Payer: Aetna Medicare Advantage |
$479.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$407.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$407.29
|
| 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 |
$407.29
|
| Rate for Payer: Cigna Commercial |
$798.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$479.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$239.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.33
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
OP
|
$1,597.20
|
|
|
Service Code
|
HCPCS 19283RT
|
| Hospital Charge Code |
94064013R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$606.94
|
| Rate for Payer: Aetna Medicare Advantage |
$479.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$407.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$407.29
|
| 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 |
$407.29
|
| Rate for Payer: Cigna Commercial |
$798.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$479.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$239.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.33
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
IP
|
$3,194.40
|
|
|
Service Code
|
HCPCS 1928350
|
| Hospital Charge Code |
94064013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$479.16 |
| Max. Negotiated Rate |
$479.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$479.16
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
OP
|
$3,194.40
|
|
|
Service Code
|
HCPCS 1928350
|
| Hospital Charge Code |
94064013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$1,213.87
|
| Rate for Payer: Aetna Medicare Advantage |
$958.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$814.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$814.57
|
| 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 |
$814.57
|
| Rate for Payer: Cigna Commercial |
$1,597.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$958.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$479.16
|
| Rate for Payer: UnitedHealthcare Community & State |
$76.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$84.65
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
IP
|
$1,597.20
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
87502811
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.58 |
| Max. Negotiated Rate |
$239.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$239.58
|
|
