|
RT RADIOELEM INTERSTIT SIMPLE
|
Facility
|
OP
|
$842.25
|
|
|
Service Code
|
HCPCS 77776
|
| Hospital Charge Code |
4800790
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Aetna Commercial |
$320.06
|
| Rate for Payer: Aetna Medicare Advantage |
$252.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$214.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$214.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$214.77
|
| Rate for Payer: Cigna Commercial |
$421.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$252.68
|
| Rate for Payer: Oxford Commercial |
$3,906.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,852.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.32
|
|
|
RT RADIOELEM INTERSTIT SIMPLE
|
Facility
|
IP
|
$842.25
|
|
|
Service Code
|
HCPCS 77776
|
| Hospital Charge Code |
4800790
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$126.34 |
| Max. Negotiated Rate |
$126.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.34
|
|
|
RT RADIOELEM INTRACAV COMPLEX
|
Facility
|
OP
|
$773.80
|
|
|
Service Code
|
HCPCS 77763
|
| Hospital Charge Code |
4800280
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Aetna Commercial |
$2,250.61
|
| Rate for Payer: Aetna Medicare Advantage |
$2,680.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,986.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,986.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$827.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,986.77
|
| Rate for Payer: Cigna Commercial |
$1,658.57
|
| Rate for Payer: Cigna Medicare Advantage |
$579.20
|
| Rate for Payer: Clover Medicare Advantage |
$786.06
|
| Rate for Payer: EmblemHealth Commercial |
$2,482.29
|
| Rate for Payer: Humana Medicare Advantage |
$852.25
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$827.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.14
|
| Rate for Payer: Oxford Commercial |
$3,906.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,852.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$827.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$827.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.51
|
|
|
RT RADIOELEM INTRACAV COMPLEX
|
Facility
|
IP
|
$773.80
|
|
|
Service Code
|
HCPCS 77763
|
| Hospital Charge Code |
4800280
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$116.07 |
| Max. Negotiated Rate |
$116.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.07
|
|
|
RT RADIOELEM INTRACAV INTERM
|
Facility
|
OP
|
$642.60
|
|
|
Service Code
|
HCPCS 77762
|
| Hospital Charge Code |
4800272
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Aetna Commercial |
$1,785.49
|
| Rate for Payer: Aetna Medicare Advantage |
$2,126.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,369.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,369.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$656.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,369.52
|
| Rate for Payer: Cigna Commercial |
$1,315.81
|
| Rate for Payer: Cigna Medicare Advantage |
$459.50
|
| Rate for Payer: Clover Medicare Advantage |
$623.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,969.29
|
| Rate for Payer: Humana Medicare Advantage |
$676.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$656.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$192.78
|
| Rate for Payer: Oxford Commercial |
$3,906.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,852.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$656.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$656.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.03
|
|
|
RT RADIOELEM INTRACAV INTERM
|
Facility
|
IP
|
$642.60
|
|
|
Service Code
|
HCPCS 77762
|
| Hospital Charge Code |
4800272
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.39
|
|
|
RT RADIOELEM INTRACAV SIMPLE
|
Facility
|
IP
|
$2,368.63
|
|
|
Service Code
|
HCPCS 77761
|
| Hospital Charge Code |
4800264
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$355.29 |
| Max. Negotiated Rate |
$355.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$355.29
|
|
|
RT RADIOELEM INTRACAV SIMPLE
|
Facility
|
OP
|
$2,368.63
|
|
|
Service Code
|
HCPCS 77761
|
| Hospital Charge Code |
4800264
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Aetna Commercial |
$1,785.49
|
| Rate for Payer: Aetna Medicare Advantage |
$2,126.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,369.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,369.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$656.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,369.52
|
| Rate for Payer: Cigna Commercial |
$1,315.81
|
| Rate for Payer: Cigna Medicare Advantage |
$459.50
|
| Rate for Payer: Clover Medicare Advantage |
$623.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,969.29
|
| Rate for Payer: Humana Medicare Advantage |
$676.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$656.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$710.59
|
| Rate for Payer: Oxford Commercial |
$3,906.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$355.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,852.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$57.08
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$656.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$656.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$62.77
|
|
|
RT SIMULATION COMPLEX
|
Facility
|
OP
|
$1,394.60
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
4800041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$33.61 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Aetna Commercial |
$1,209.94
|
| Rate for Payer: Aetna Medicare Advantage |
$1,441.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,605.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,605.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$444.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,605.70
|
| Rate for Payer: Cigna Commercial |
$891.65
|
| Rate for Payer: Cigna Medicare Advantage |
$311.38
|
| Rate for Payer: Clover Medicare Advantage |
$422.59
|
| Rate for Payer: EmblemHealth Commercial |
$1,334.49
|
| Rate for Payer: Humana Medicare Advantage |
$458.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$444.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$418.38
|
| Rate for Payer: Oxford Commercial |
$3,906.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$209.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,852.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$444.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$444.83
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$107.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.96
|
|
|
RT SIMULATION COMPLEX
|
Facility
|
IP
|
$1,394.60
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
4800041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$209.19 |
| Max. Negotiated Rate |
$209.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$209.19
|
|
|
RT SIMULATION INTERMED
|
Facility
|
IP
|
$858.90
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
4800033
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$128.84 |
| Max. Negotiated Rate |
$128.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.84
|
|
|
RT SIMULATION INTERMED
|
Facility
|
OP
|
$858.90
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
4800033
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Aetna Commercial |
$1,209.94
|
| Rate for Payer: Aetna Medicare Advantage |
$1,441.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,605.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,605.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$444.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,605.70
|
| Rate for Payer: Cigna Commercial |
$891.65
|
| Rate for Payer: Cigna Medicare Advantage |
$311.38
|
| Rate for Payer: Clover Medicare Advantage |
$422.59
|
| Rate for Payer: EmblemHealth Commercial |
$1,334.49
|
| Rate for Payer: Humana Medicare Advantage |
$458.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$444.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$257.67
|
| Rate for Payer: Oxford Commercial |
$3,906.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,852.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$444.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$444.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.76
|
|
|
RT SIMULATION SIMPLE
|
Facility
|
OP
|
$545.30
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
4800025
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Aetna Commercial |
$434.33
|
| Rate for Payer: Aetna Medicare Advantage |
$517.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$576.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$576.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$159.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$576.40
|
| Rate for Payer: Cigna Commercial |
$320.09
|
| Rate for Payer: Cigna Medicare Advantage |
$111.78
|
| Rate for Payer: Clover Medicare Advantage |
$151.70
|
| Rate for Payer: EmblemHealth Commercial |
$479.04
|
| Rate for Payer: Humana Medicare Advantage |
$164.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$159.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.59
|
| Rate for Payer: Oxford Commercial |
$3,906.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,852.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$159.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$159.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.45
|
|
|
RT SIMULATION SIMPLE
|
Facility
|
IP
|
$545.30
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
4800025
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$81.80 |
| Max. Negotiated Rate |
$81.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.80
|
|
|
RT SM153 PER 50 mCi
|
Facility
|
IP
|
$1,932.20
|
|
| Hospital Charge Code |
4800692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$289.83 |
| Max. Negotiated Rate |
$467.59 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$467.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$289.83
|
|
|
RT SM153 PER 50 mCi
|
Facility
|
OP
|
$1,932.20
|
|
| Hospital Charge Code |
4800692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$966.10 |
| Rate for Payer: Aetna Commercial |
$734.24
|
| Rate for Payer: Aetna Medicare Advantage |
$579.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$492.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$492.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$492.71
|
| Rate for Payer: Cigna Commercial |
$966.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$467.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$289.83
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$51.20
|
|
|
RT SM153 RADIONUCLIDE THERAPY
|
Facility
|
IP
|
$1,433.00
|
|
|
Service Code
|
HCPCS 79101
|
| Hospital Charge Code |
4800690
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$214.95 |
| Max. Negotiated Rate |
$214.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.95
|
|
|
RT SM153 RADIONUCLIDE THERAPY
|
Facility
|
OP
|
$1,433.00
|
|
|
Service Code
|
HCPCS 79101
|
| Hospital Charge Code |
4800690
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$34.54 |
| Max. Negotiated Rate |
$5,021.00 |
| Rate for Payer: Aetna Commercial |
$754.01
|
| Rate for Payer: Aetna Medicare Advantage |
$898.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,000.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,000.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$277.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$216.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,000.64
|
| Rate for Payer: Cigna Commercial |
$555.67
|
| Rate for Payer: Cigna Medicare Advantage |
$194.05
|
| Rate for Payer: Clover Medicare Advantage |
$263.35
|
| Rate for Payer: EmblemHealth Commercial |
$831.63
|
| Rate for Payer: Humana Medicare Advantage |
$285.53
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$277.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$429.90
|
| Rate for Payer: Oxford Commercial |
$3,120.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,021.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.54
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$277.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$277.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.97
|
|
|
RT SPECIAL PLAN HEMI/TOTAL BDY
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
4800090
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$97.35 |
| Max. Negotiated Rate |
$97.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.35
|
|
|
RT SPECIAL PLAN HEMI/TOTAL BDY
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
4800090
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Aetna Commercial |
$1,209.94
|
| Rate for Payer: Aetna Medicare Advantage |
$1,441.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,605.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,605.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$444.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,605.70
|
| Rate for Payer: Cigna Commercial |
$891.65
|
| Rate for Payer: Cigna Medicare Advantage |
$311.38
|
| Rate for Payer: Clover Medicare Advantage |
$422.59
|
| Rate for Payer: EmblemHealth Commercial |
$1,334.49
|
| Rate for Payer: Humana Medicare Advantage |
$458.17
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$444.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.70
|
| Rate for Payer: Oxford Commercial |
$3,906.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,852.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$444.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$444.83
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$425.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.20
|
|
|
RT SPECIAL RAD DOSIMETRY-TLD'S
|
Facility
|
IP
|
$794.90
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
4800108
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$119.23 |
| Max. Negotiated Rate |
$119.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$119.23
|
|
|
RT SPECIAL RAD DOSIMETRY-TLD'S
|
Facility
|
OP
|
$794.90
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
4800108
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Aetna Commercial |
$434.33
|
| Rate for Payer: Aetna Medicare Advantage |
$517.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$576.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$576.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$159.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$576.40
|
| Rate for Payer: Cigna Commercial |
$320.09
|
| Rate for Payer: Cigna Medicare Advantage |
$111.78
|
| Rate for Payer: Clover Medicare Advantage |
$151.70
|
| Rate for Payer: EmblemHealth Commercial |
$479.04
|
| Rate for Payer: Humana Medicare Advantage |
$164.47
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$159.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.47
|
| Rate for Payer: Oxford Commercial |
$3,906.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$119.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,852.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$159.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$159.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.06
|
|
|
RT SPECIAL TREATMENT PROCEDURE
|
Facility
|
IP
|
$2,681.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
4800760
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$402.15 |
| Max. Negotiated Rate |
$402.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$402.15
|
|
|
RT SPECIAL TREATMENT PROCEDURE
|
Facility
|
OP
|
$2,681.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
4800760
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$64.61 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Aetna Commercial |
$1,785.49
|
| Rate for Payer: Aetna Medicare Advantage |
$2,126.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,369.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,369.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$656.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,369.52
|
| Rate for Payer: Cigna Commercial |
$1,315.81
|
| Rate for Payer: Cigna Medicare Advantage |
$459.50
|
| Rate for Payer: Clover Medicare Advantage |
$623.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,969.29
|
| Rate for Payer: Humana Medicare Advantage |
$676.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$656.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$804.30
|
| Rate for Payer: Oxford Commercial |
$3,906.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$402.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,852.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$64.61
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$656.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$656.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$71.05
|
|
|
RT SR89 PER mCi
|
Facility
|
IP
|
$1,607.05
|
|
| Hospital Charge Code |
4800660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$241.06 |
| Max. Negotiated Rate |
$388.91 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$388.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$241.06
|
|
